1114188133 NPI number — MRS. ANDREA D CONATSER DI

Table of content: MRS. ANDREA D CONATSER DI (NPI 1114188133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114188133 NPI number — MRS. ANDREA D CONATSER DI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONATSER
Provider First Name:
ANDREA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DI
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DEVELOPMENTAL INTERVENTION
Provider Other First Name:
GATEWAY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1114188133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5455 W HIGHWAY 60
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OWINGSVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40360-9027
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-585-8525
Provider Business Mailing Address Fax Number:
859-498-5198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5455 W HIGHWAY 60
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OWINGSVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40360-9027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-585-8525
Provider Business Practice Location Address Fax Number:
859-498-5198
Provider Enumeration Date:
06/23/2008

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: 222Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02852 . This is a "KY EARLY INTERVENTION SYSTEM PROVIDER ID#" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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