1356597124 NPI number — MRS. GINGER KATHERINE CHEEK LAC

Table of content: MRS. GINGER KATHERINE CHEEK LAC (NPI 1356597124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356597124 NPI number — MRS. GINGER KATHERINE CHEEK LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEEK
Provider First Name:
GINGER
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GIDDENS
Provider Other First Name:
GINGER
Provider Other Middle Name:
KATHERINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356597124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7255
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72217-7255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-918-8767
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5905 FOREST PL
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72207-5244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-666-4949
Provider Business Practice Location Address Fax Number:
501-660-6840
Provider Enumeration Date:
08/13/2008

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: 101Y00000X , with the licence number:  A0807043 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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