1295164515 NPI number — MRS. KENDALL MERYL AYERS R.N, C.R.N.P.

Table of content: MRS. KENDALL MERYL AYERS R.N, C.R.N.P. (NPI 1295164515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295164515 NPI number — MRS. KENDALL MERYL AYERS R.N, C.R.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AYERS
Provider First Name:
KENDALL
Provider Middle Name:
MERYL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N, C.R.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FAVOR
Provider Other First Name:
KENDALL
Provider Other Middle Name:
MERYL
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295164515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E BOULDER ST
Provider Second Line Business Mailing Address:
SUITE 4N 4145B
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80909-5533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E BOULDER ST
Provider Second Line Business Practice Location Address:
SUITE 4N 4145B
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-5533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-243-3839
Provider Business Practice Location Address Fax Number:
954-851-1840
Provider Enumeration Date:
11/07/2013

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: 363LN0000X , with the licence number:  AYE104379660 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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