1487098414 NPI number — MRS. KADIE DEANN TARR

Table of content: MRS. KADIE DEANN TARR (NPI 1487098414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487098414 NPI number — MRS. KADIE DEANN TARR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TARR
Provider First Name:
KADIE
Provider Middle Name:
DEANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOUX
Provider Other First Name:
KADIE
Provider Other Middle Name:
DEANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487098414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/21/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
218 S CREEK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28540-9628
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-478-5074
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4301 N FEDERAL HWY STE 2
Provider Second Line Business Practice Location Address:
BUTTERFLY EFFECTS LLC
Provider Business Practice Location Address City Name:
POMPANO BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33064-6519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-880-9270
Provider Business Practice Location Address Fax Number:
954-342-0273
Provider Enumeration Date:
04/21/2013

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: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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