1992844955 NPI number — NANCY R PLUNK LPC/MHSP

Table of content: NANCY R PLUNK LPC/MHSP (NPI 1992844955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992844955 NPI number — NANCY R PLUNK LPC/MHSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLUNK
Provider First Name:
NANCY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC/MHSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARRELL
Provider Other First Name:
NANCY
Provider Other Middle Name:
CLENNEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC/MHSP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992844955
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
142 OLD BELLS LOOP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38305-9609
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
731-697-7185
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 LAMAR CIRCLE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38305-1528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
731-697-7185
Provider Business Practice Location Address Fax Number:
731-736-2530
Provider Enumeration Date:
02/06/2007

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: 101YP2500X , with the licence number:  2682 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: Q016792 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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