1982910550 NPI number — MRS. JULIE CAMILLE CARPENTER FNP

Table of content: MRS. JULIE CAMILLE CARPENTER FNP (NPI 1982910550)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982910550 NPI number — MRS. JULIE CAMILLE CARPENTER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER
Provider First Name:
JULIE
Provider Middle Name:
CAMILLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1982910550
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10880
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESCOTT
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86304-0880
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-759-5987
Provider Business Mailing Address Fax Number:
928-458-2039

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
114 SE CHURCH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUBLIMITY
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97385-9424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-769-2259
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2010

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:  202211101NP-PP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 079371 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 240030 . This is a "ARIZONA STATE BOARD OF NURSING" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com