1174574057 NPI number — MS. TRACEY TURNER-KEYSER MA, ADTR, LPC

Table of content: KATELYN O'DANIEL (NPI 1750922514)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174574057 NPI number — MS. TRACEY TURNER-KEYSER MA, ADTR, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURNER-KEYSER
Provider First Name:
TRACEY
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, ADTR, LPC
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:
1174574057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5089 US HIGHWAY 64 W
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
PITTSBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27312-6829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-545-9833
Provider Business Mailing Address Fax Number:
919-545-9832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5089 US HIGHWAY 64 W
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PITTSBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27312-6829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-545-9833
Provider Business Practice Location Address Fax Number:
919-545-9832
Provider Enumeration Date:
05/15/2006

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: 101YM0800X , with the licence number:  4468 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6102047 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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