1487821823 NPI number — JUDY DUNN L.P.C.

Table of content: JUDY DUNN L.P.C. (NPI 1487821823)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487821823 NPI number — JUDY DUNN L.P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNN
Provider First Name:
JUDY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.P.C.
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:
1487821823
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7345 HIGHWAY 62 W
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GASSVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72635-8636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-435-5511
Provider Business Mailing Address Fax Number:
870-435-5513

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7345 HIGHWAY 62 W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GASSVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72635-8636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-435-5511
Provider Business Practice Location Address Fax Number:
870-435-5513
Provider Enumeration Date:
05/14/2008

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: 101Y00000X , with the licence number:  A0802010 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: P0903018 , 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)