1063755411 NPI number — VICKY LYNN KESSLER CACIII

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063755411 NPI number — VICKY LYNN KESSLER CACIII

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KESSLER
Provider First Name:
VICKY
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CACIII
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KESSLER-DUMAS
Provider Other First Name:
VIDKY
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1063755411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
515 28 3/4 RD
Provider Second Line Business Mailing Address:
BLDG A
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81501-5016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-683-7107
Provider Business Mailing Address Fax Number:
970-683-7167

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 SOUTH LINCOLN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STEAMBOAT SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80487
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-879-2141
Provider Business Practice Location Address Fax Number:
970-879-7912
Provider Enumeration Date:
04/04/2013

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: 101YA0400X , with the licence number:  7228 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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