1225111289 NPI number — JUDY A DOWD PA-C

Table of content: JUDY A DOWD PA-C (NPI 1225111289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225111289 NPI number — JUDY A DOWD PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOWD
Provider First Name:
JUDY
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCDANIEL
Provider Other First Name:
JUDY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1225111289
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2902 SW ASBURY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOPEKA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66614-4466
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-270-0187
Provider Business Mailing Address Fax Number:
785-270-0168

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2902 SW ASBURY DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66614-4466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-270-0187
Provider Business Practice Location Address Fax Number:
785-270-0168
Provider Enumeration Date:
10/23/2006

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: 363A00000X , with the licence number:  15-00481 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100362510A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 042340 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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