1225081342 NPI number — MS. KATHLEEN P NEAL APRN

Table of content: MS. KATHLEEN P NEAL APRN (NPI 1225081342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225081342 NPI number — MS. KATHLEEN P NEAL APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEAL
Provider First Name:
KATHLEEN
Provider Middle Name:
P
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1225081342
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
180 BOONE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37615-4479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-794-0827
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10805 HARDING DRIVE
Provider Second Line Business Practice Location Address:
HALLMARK HEALTH SERVICES
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37932
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-675-6444
Provider Business Practice Location Address Fax Number:
865-675-6008
Provider Enumeration Date:
05/18/2006

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: 363LA2200X , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: APN 0000012042 . This is a "APN NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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