1083163984 NPI number — MRS. FEONIA FARRAH KEARBY R.D.H

Table of content: MRS. FEONIA FARRAH KEARBY R.D.H (NPI 1083163984)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083163984 NPI number — MRS. FEONIA FARRAH KEARBY R.D.H

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEARBY
Provider First Name:
FEONIA
Provider Middle Name:
FARRAH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.D.H
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FERRIL
Provider Other First Name:
FEONIA
Provider Other Middle Name:
FARRAH
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.D.H
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1083163984
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 W WISCONSIN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MILWAUKEE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53233-2186
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-288-6790
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 SPRINGHALL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOOSE CREEK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29445-5351
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-773-3534
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2016

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: 124Q00000X , with the licence number:  020015474 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 124Q00000X , with the licence number: 1002971-16 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 390806251 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390806251 . This is a "FORWARD HEALT" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".