1083939425 NPI number — MRS. MARILYN LOUISE RHOADS ARNP

Table of content: MRS. MARILYN LOUISE RHOADS ARNP (NPI 1083939425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083939425 NPI number — MRS. MARILYN LOUISE RHOADS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RHOADS
Provider First Name:
MARILYN
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1083939425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
322 LINKS DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIMPSONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40067-6571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-410-1357
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
615 WASHINGTON STREET
Provider Second Line Business Practice Location Address:
MERCY CLINIC
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-647-4668
Provider Business Practice Location Address Fax Number:
502-647-4615
Provider Enumeration Date:
03/29/2010

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: 164W00000X , with the licence number:  1048667 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 2093P , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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