1467574251 NPI number — JODI ANN SEGEL RN FNP C

Table of content: JODI ANN SEGEL RN FNP C (NPI 1467574251)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467574251 NPI number — JODI ANN SEGEL RN FNP C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGEL
Provider First Name:
JODI
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN FNP C
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:
1467574251
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1509 DOROTHY NICHOLS LN UNIT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78957-1741
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
833-588-6967
Provider Business Mailing Address Fax Number:
888-486-6260

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1509 DOROTHY NICHOLS LN UNIT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SMITHVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78957-1741
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-588-6967
Provider Business Practice Location Address Fax Number:
888-486-6260
Provider Enumeration Date:
04/04/2007

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: 363LF0000X , with the licence number:  638421 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 191426902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 847N93 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".