1215985130 NPI number — DR. CHRISTINE L KELLEY-PATTESON MD

Table of content: DR. CHRISTINE L KELLEY-PATTESON MD (NPI 1215985130)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215985130 NPI number — DR. CHRISTINE L KELLEY-PATTESON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KELLEY-PATTESON
Provider First Name:
CHRISTINE
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1215985130
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
170 W 106TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46290-1004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-575-0330
Provider Business Mailing Address Fax Number:
317-846-5719

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 W 106TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46290-1004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-575-0330
Provider Business Practice Location Address Fax Number:
317-846-5719
Provider Enumeration Date:
05/04/2006

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: 174400000X , with the licence number:  01050353A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com