1528180700 NPI number — CHRISTINA L DUNCAN PHD

Table of content: CHRISTINA L DUNCAN PHD (NPI 1528180700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528180700 NPI number — CHRISTINA L DUNCAN PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUNCAN
Provider First Name:
CHRISTINA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ADAMS
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528180700
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
519 LATHAM DRIVE
Provider Second Line Business Mailing Address:
CENTER FOR CHILDREN
Provider Business Mailing Address City Name:
LOWELL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-750-0125
Provider Business Mailing Address Fax Number:
479-750-0323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
519 LATHAM DR
Provider Second Line Business Practice Location Address:
CENTER FOR CHILDREN
Provider Business Practice Location Address City Name:
LOWELL
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72745-8360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-750-0125
Provider Business Practice Location Address Fax Number:
479-750-0323
Provider Enumeration Date:
04/06/2007

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: 103TC2200X , with the licence number:  08-09P , 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)

  • Identifier: 175864719 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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