1487644712 NPI number — MRS. KELLI MAY DROST APRN, BC, FNP

Table of content: MRS. KELLI MAY DROST APRN, BC, FNP (NPI 1487644712)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487644712 NPI number — MRS. KELLI MAY DROST APRN, BC, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DROST
Provider First Name:
KELLI
Provider Middle Name:
MAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN, BC, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIDSON
Provider Other First Name:
KELLI
Provider Other Middle Name:
MEREDITH MAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1487644712
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
108 HARVEST OAKS CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST MONROE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71292-0000
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-537-0323
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
427 S VINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71220-4513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-556-3333
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2005

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: 163W00000X , with the licence number:  075341 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 03722 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020318 . This is a "PRESCRIPTIVE AUTHORITY" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: P00149461 . This is a "RAILROAD M/CARE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".
  • Identifier: 1181790 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".