1518019009 NPI number — MISS KIMBERLY KAY JONES LCSW

Table of content: MISS KIMBERLY KAY JONES LCSW (NPI 1518019009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518019009 NPI number — MISS KIMBERLY KAY JONES LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JONES
Provider First Name:
KIMBERLY
Provider Middle Name:
KAY
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LCSW
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:
1518019009
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
344 W MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAVERLY
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23890-3235
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-834-8871
Provider Business Mailing Address Fax Number:
804-834-8875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
344 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WAVERLY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23890-3235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-834-8871
Provider Business Practice Location Address Fax Number:
804-834-8875
Provider Enumeration Date:
01/17/2007

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008937311 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3207051 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 089543 . This is a "SENTARA PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 435332 . This is a "ANTHEM PROVIDER NUMBER" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com