1427204643 NPI number — MS. NATASSIA NICHOLE WEATHARLY LPC

Table of content: MS. NATASSIA NICHOLE WEATHARLY LPC (NPI 1427204643)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427204643 NPI number — MS. NATASSIA NICHOLE WEATHARLY LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WEATHARLY
Provider First Name:
NATASSIA
Provider Middle Name:
NICHOLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERNARD
Provider Other First Name:
NATASSIA
Provider Other Middle Name:
NICHOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427204643
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5905 FOREST PLACE
Provider Second Line Business Mailing Address:
SUITE 230
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-777-3200
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5905 FOREST PLACE
Provider Second Line Business Practice Location Address:
SUITE 230
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-777-3200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/08/2008

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: P1202024 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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