1083684740 NPI number — SUSAN GATELEY A.P.N.

Table of content: SUSAN GATELEY A.P.N. (NPI 1083684740)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083684740 NPI number — SUSAN GATELEY A.P.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GATELEY
Provider First Name:
SUSAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A.P.N.
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:
1083684740
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLARKSVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72830-0668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-754-8384
Provider Business Mailing Address Fax Number:
479-754-7141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 W MCKENNON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLARKSVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72830-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-754-8384
Provider Business Practice Location Address Fax Number:
479-754-7141
Provider Enumeration Date:
01/25/2006

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: 363LP2300X , with the licence number:  A01730 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020407900 . This is a "BLACK LUNG PROGRAM" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 5U698 . This is a "BLUE CROSS BLUE SHIELD AR" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 0062731 . This is a "UMWA H&R FUNDS" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 0790780001 . This is a "PALMETTO GBA" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 150985758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 435205 . This is a "HEALTH LINK" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: XX12984 . This is a "HEALTH PLUS OF MICHIGAN" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com