1306251152 NPI number — KYLIE ANNE PALERMO DPT

Table of content: HUGHES JOHN BURRIDGE PA-C (NPI 1902313414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306251152 NPI number — KYLIE ANNE PALERMO DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PALERMO
Provider First Name:
KYLIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPT
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:
1306251152
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8823 PRODUCTION LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OOLTEWAH
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37363-6511
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-226-4011
Provider Business Mailing Address Fax Number:
816-524-6115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7932 N OAK TRFY
Provider Second Line Business Practice Location Address:
STE 212
Provider Business Practice Location Address City Name:
KANSAS CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64118-1423
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-420-0286
Provider Business Practice Location Address Fax Number:
816-420-8207
Provider Enumeration Date:
06/30/2014

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: 225100000X , with the licence number:  11-04843 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X , with the licence number: 2014023633 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50779012 . This is a "BCBS-KC" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA4370080 . This is a "MEDICARE PTAN" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 000857 . This is a "OPTUM" identifier . This identifiers is of the category "OTHER".
  • Identifier: KA2868060 . This is a "MEDICARE PTAN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: USES NPI . This is a "BCBS-KANSAS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com