1437575123 NPI number — DR. KIMBERLY FEDDERLY PHARMD, MS H.N.

Table of content: DR. KIMBERLY FEDDERLY PHARMD, MS H.N. (NPI 1437575123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437575123 NPI number — DR. KIMBERLY FEDDERLY PHARMD, MS H.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEDDERLY
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, MS H.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOPPER
Provider Other First Name:
KIMBERLY
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1437575123
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
103 PONDEROSA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KALISPELL
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59901-6833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-270-7957
Provider Business Mailing Address Fax Number:
406-755-8432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 PONDEROSA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KALISPELL
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59901-6833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-270-7957
Provider Business Practice Location Address Fax Number:
406-755-8432
Provider Enumeration Date:
03/05/2014

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: 183500000X , with the licence number:  011376 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1835N1003X , with the licence number: 4925 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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