1093958910 NPI number — KATHRYN HOLLAND TIMMONS M.S.W.

Table of content: KATHRYN HOLLAND TIMMONS M.S.W. (NPI 1093958910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093958910 NPI number — KATHRYN HOLLAND TIMMONS M.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TIMMONS
Provider First Name:
KATHRYN
Provider Middle Name:
HOLLAND
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREEN
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093958910
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100296
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32610-0296
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-273-6083
Provider Business Mailing Address Fax Number:
352-294-8088

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 SW 16TH AVE BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32608-1516
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-273-6083
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2009

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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