1003813023 NPI number — MRS. KATRINA H DENEGRI GNP

Table of content: MRS. KATRINA H DENEGRI GNP (NPI 1003813023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003813023 NPI number — MRS. KATRINA H DENEGRI GNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DENEGRI
Provider First Name:
KATRINA
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
GNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARDIN
Provider Other First Name:
KATRINA
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
GNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1003813023
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 820406
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38182-0406
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-725-0872
Provider Business Mailing Address Fax Number:
901-278-6934

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1726 POPLAR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38104-6426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-725-0872
Provider Business Practice Location Address Fax Number:
901-278-6934
Provider Enumeration Date:
07/05/2005

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: 363LG0600X , with the licence number:  APN0000008186 , 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: 3908110 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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