1336173913 NPI number — JACKIE CURL C.R.N.F.A

Table of content: JACKIE CURL C.R.N.F.A (NPI 1336173913)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336173913 NPI number — JACKIE CURL C.R.N.F.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CURL
Provider First Name:
JACKIE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
C.R.N.F.A
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:
1336173913
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 51440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79159-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-355-9595
Provider Business Mailing Address Fax Number:
806-353-1589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7120 SW 9TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79106-1704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-463-2251
Provider Business Practice Location Address Fax Number:
806-463-2252
Provider Enumeration Date:
07/10/2006

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: 364SM0705X , with the licence number:  525114 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0006HT . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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