1336784206 NPI number — BARBARA KINKLE PA INC., A PHYSICIAN ASSISTANT CORPORATION

Table of content: DR. STEPHANIE LYNN PRO PHARMD (NPI 1043594856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336784206 NPI number — BARBARA KINKLE PA INC., A PHYSICIAN ASSISTANT CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BARBARA KINKLE PA INC., A PHYSICIAN ASSISTANT CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336784206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24575 HUNT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORNING
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
96021-8607
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:
24575 HUNT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORNING
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
96021-8607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-356-9245
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2019

Additional Information

Authorized Official

Authorized Official Last Name:
KINKLE
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
530-356-9245

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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