1265481709 NPI number — MS. STEPHANNIE DAWN GILKEY-NICOL D.C.

Table of content: MS. STEPHANNIE DAWN GILKEY-NICOL D.C. (NPI 1265481709)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265481709 NPI number — MS. STEPHANNIE DAWN GILKEY-NICOL D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILKEY-NICOL
Provider First Name:
STEPHANNIE
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
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:
1265481709
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
412 PENNSYLVANIA AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLTON
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66436-1803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-364-9003
Provider Business Mailing Address Fax Number:
785-364-9006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 PENNSYLVANIA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOLTON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66436-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-364-9003
Provider Business Practice Location Address Fax Number:
785-364-9006
Provider Enumeration Date:
05/10/2006

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: 111N00000X , with the licence number:  01-04759 , 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: 062143 . This is a "BCBS OF KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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