1003855131 NPI number — KAREN DAY PT

Table of content: KAREN DAY PT (NPI 1003855131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003855131 NPI number — KAREN DAY PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAY
Provider First Name:
KAREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WELLS
Provider Other First Name:
KAREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1003855131
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
350 NEW FIDELITY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARNER
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27529-2665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-373-2919
Provider Business Mailing Address Fax Number:
410-648-4878

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2717 PULASKI HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWARK
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19702-3960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-292-3454
Provider Business Practice Location Address Fax Number:
302-292-3464
Provider Enumeration Date:
06/05/2006

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: 225100000X , with the licence number:  J1-0000865 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2449056 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2781278 . This is a "HIGHMARK" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: P00713270 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0287367000 . This is a "AMERIHEALTH" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1003855131 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: AC44-0029 . This is a "CAREFIRST" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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