1235588534 NPI number — MRS. KAY SULLIVAN BASSETT H.I.S.

Table of content: MRS. KAY SULLIVAN BASSETT H.I.S. (NPI 1235588534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235588534 NPI number — MRS. KAY SULLIVAN BASSETT H.I.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BASSETT
Provider First Name:
KAY
Provider Middle Name:
SULLIVAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
H.I.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BASSETT
Provider Other First Name:
CARLETTA
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
H.I.S.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235588534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1112 W 6TH ST
Provider Second Line Business Mailing Address:
STE 216
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66044-2215
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-841-1107
Provider Business Mailing Address Fax Number:
785-841-1173

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1112 W 6TH ST
Provider Second Line Business Practice Location Address:
STE 216
Provider Business Practice Location Address City Name:
LAWRENCE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66044-2215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-841-1107
Provider Business Practice Location Address Fax Number:
785-841-1173
Provider Enumeration Date:
06/07/2016

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: 237700000X , with the licence number:  1645 , 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: 201157650A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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