1043458383 NPI number — KOPPER TOP LIFE LEARNING CENTER, INC.

Table of content: ASHLEY NICHOLE SMITH APRN (NPI 1659088292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043458383 NPI number — KOPPER TOP LIFE LEARNING CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KOPPER TOP LIFE LEARNING CENTER, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1043458383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6657 KIMESVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LIBERTY
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27298-9108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-565-9723
Provider Business Mailing Address Fax Number:
336-565-0644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6657 KIMESVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27298-9108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-565-9723
Provider Business Practice Location Address Fax Number:
336-565-0644
Provider Enumeration Date:
01/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MERIDITH
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
EXECUTIVE DIRECTOR/REC. THERAPIST
Authorized Official Telephone Number:
336-565-9723

Provider Taxonomy Codes

  • Taxonomy code: 251V00000X , with the licence number:  196 , 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)





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