1477921591 NPI number — MYERS WOUND CARE CONSULTANTS OF NEVADA, P.C.

Table of content: (NPI 1477921591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477921591 NPI number — MYERS WOUND CARE CONSULTANTS OF NEVADA, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MYERS WOUND CARE CONSULTANTS OF NEVADA, P.C.
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:
6
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:
1477921591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7702 MEANY AVE STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAKERSFIELD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93308-5199
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
661-843-7841
Provider Business Mailing Address Fax Number:
661-864-7943

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 PINE RIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE BIRD
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83554-9401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-849-2489
Provider Business Practice Location Address Fax Number:
661-864-7943
Provider Enumeration Date:
09/05/2015

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
330-979-3424

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  NP17829 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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