1457595977 NPI number — KIMYATTA M. FRAZIER R.N., DOULA

Table of content: MS. DOROTHY G ST JOHN LCSW (NPI 1558574665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457595977 NPI number — KIMYATTA M. FRAZIER R.N., DOULA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FRAZIER
Provider First Name:
KIMYATTA
Provider Middle Name:
M.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N., DOULA
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:
1457595977
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2600 W 9TH ST
Provider Second Line Business Mailing Address:
1 SW
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013-2040
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-497-7399
Provider Business Mailing Address Fax Number:
610-497-7472

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 W 9TH ST
Provider Second Line Business Practice Location Address:
1 SW
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-2040
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-497-7399
Provider Business Practice Location Address Fax Number:
610-497-7472
Provider Enumeration Date:
04/28/2009

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: 163W00000X , with the licence number:  L1-0034895 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN95312923 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WH0200X , with the licence number: RN524236L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WM0102X , with the licence number: RN524236L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WM0102X , with the licence number: 26NR11623500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 374J00000X , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: RN524236L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 838612 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: 26NR11623500 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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