1083938534 NPI number — HEATHER M FELTON M.D.

Table of content: HEATHER M FELTON M.D. (NPI 1083938534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083938534 NPI number — HEATHER M FELTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FELTON
Provider First Name:
HEATHER
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DETTRO
Provider Other First Name:
HEATHER
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1083938534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 909
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:
40201-0909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-0700
Provider Business Mailing Address Fax Number:
502-588-0701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
982 EASTERN PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40217-1566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-588-0700
Provider Business Practice Location Address Fax Number:
502-588-0701
Provider Enumeration Date:
03/25/2010

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: 208000000X , with the licence number:  45845 , 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: 201160370 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100171530 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".