1316977275 NPI number — CAROLE R SWEAT APRN, MSN

Table of content: CAROLE R SWEAT APRN, MSN (NPI 1316977275)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316977275 NPI number — CAROLE R SWEAT APRN, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWEAT
Provider First Name:
CAROLE
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN, MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOUDREAU
Provider Other First Name:
CAROLE
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316977275
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 776351
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHICAGO
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60677-6351
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-588-9490
Provider Business Mailing Address Fax Number:
502-272-5116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9880 ANGIES WAY
Provider Second Line Business Practice Location Address:
SUTIE 350
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40241-2851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-423-9595
Provider Business Practice Location Address Fax Number:
502-719-0161
Provider Enumeration Date:
07/04/2006

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: 363LW0102X , with the licence number:  1068394 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 3004402 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200876590 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 50011024 . This is a "PASSPORT SPECIALITY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50011025 . This is a "PASSPORT SPECIALIST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50034508 . This is a "PASSPORT (WSP)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: K028570 . This is a "MEDICARE PTAN (WSP)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000000535084 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3946879 . This is a "CIGNA (WSP)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7801436200 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000536025 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000732544 . This is a "ANTHEM (WSP)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 000057121Y . This is a "HUMANA (WSP)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 128620 . This is a "SIHO - KCPAG" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 128620 . This is a "SIHO (WSP)" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 50011023 . This is a "PASSPORT PCP" identifier . This identifiers is of the category "OTHER".




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