1033345095 NPI number — MS. KATHERYN ELIZABETH SMITH MA.

Table of content: LYNDA R PEEL MD (NPI 1831168954)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033345095 NPI number — MS. KATHERYN ELIZABETH SMITH MA.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
KATHERYN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA.
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:
1033345095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
624 ROCKPORT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAYETTEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28311-6925
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-960-7768
Provider Business Mailing Address Fax Number:
910-438-0906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
555 EXECUTIVE PL STE 202
Provider Second Line Business Practice Location Address:
INTEGRATED BEHAVIORAL HEALTHCARE SERVICES, INC.
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28305-5155
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-438-0947
Provider Business Practice Location Address Fax Number:
910-438-0906
Provider Enumeration Date:
06/04/2009

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: 101YM0800X , with the licence number:  6941 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6115059 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 418620 . This is a "MHN PIN" identifier . This identifiers is of the category "OTHER".