1053510651 NPI number — TARA S KAUFFMAN ARNP

Table of content: TARA S KAUFFMAN ARNP (NPI 1053510651)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053510651 NPI number — TARA S KAUFFMAN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAUFFMAN
Provider First Name:
TARA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1053510651
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/07/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 950248
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40295-0248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-489-5730
Provider Business Mailing Address Fax Number:
502-489-5753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 KRESGE WAY
Provider Second Line Business Practice Location Address:
SUITE 60
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40207-4660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-893-7710
Provider Business Practice Location Address Fax Number:
502-893-1884
Provider Enumeration Date:
07/13/2007

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: 363L00000X , with the licence number:  44683 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 3005457 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100146890 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00992184 . This is a "RR MEDICARE KY" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000057080U . This is a "HUMANA - NCVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000525603 . This is a "ANTHEM PIN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000693050 . This is a "ANTHEM - NCVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 122021 . This is a "SIHO - NCVA" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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