1083868640 NPI number — MRS. KATHY T STIGERS M.A./CCC-A

Table of content: MRS. KATHY T STIGERS M.A./CCC-A (NPI 1083868640)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083868640 NPI number — MRS. KATHY T STIGERS M.A./CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STIGERS
Provider First Name:
KATHY
Provider Middle Name:
T
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A./CCC-A
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083868640
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1680 DUNLAWTON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT ORANGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32127-4754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
386-756-8225
Provider Business Mailing Address Fax Number:
386-767-0742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
927 N SPRING GARDEN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DELAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32720-2560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-736-7192
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X , with the licence number:  AY506 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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