1407807811 NPI number — MRS. KAREN KOELEMAY CRNA

Table of content: MRS. KAREN KOELEMAY CRNA (NPI 1407807811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407807811 NPI number — MRS. KAREN KOELEMAY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KOELEMAY
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1407807811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/09/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 EXETER RD
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38138-2954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-818-2160
Provider Business Mailing Address Fax Number:
901-682-9522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 EXETER RD
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38138-2954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-818-2160
Provider Business Practice Location Address Fax Number:
901-682-9522
Provider Enumeration Date:
05/12/2006

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: 367500000X , with the licence number:  APN 10857 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN 139171 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 04434872 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 915186829 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 127877701 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3633447 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4089877 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 5T029 . This is a "BLUE CROSS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: P00127942 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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