1235997040 NPI number — MRS. KATHLEEN DAWN LA FEVER RN

Table of content: MRS. KATHLEEN DAWN LA FEVER RN (NPI 1235997040)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235997040 NPI number — MRS. KATHLEEN DAWN LA FEVER RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LA FEVER
Provider First Name:
KATHLEEN
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1235997040
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2725 HWY 51 SOUTH
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERNANDO
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-429-1971
Provider Business Mailing Address Fax Number:
662-429-1974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
REGION IV MENTAL HEALTH SERVICES
Provider Second Line Business Practice Location Address:
2725 HWY 51 SO
Provider Business Practice Location Address City Name:
HERNANDO
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-429-1971
Provider Business Practice Location Address Fax Number:
662-429-1974
Provider Enumeration Date:
03/07/2024

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: 163W00000X , with the licence number:  887345 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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