1538420245 NPI number — MRS. LORIE JEANNE ROEVER MSN

Table of content: MR. KELLY HINSON ACNP (NPI 1558729905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538420245 NPI number — MRS. LORIE JEANNE ROEVER MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROEVER
Provider First Name:
LORIE
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUEY
Provider Other First Name:
LORIE
Provider Other Middle Name:
JEANNE
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:
1538420245
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 OCEANGATE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONG BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90802-4317
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-562-5442
Provider Business Mailing Address Fax Number:
562-499-6171

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3000 CORPORATE EXCHANGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-562-5442
Provider Business Practice Location Address Fax Number:
562-499-6171
Provider Enumeration Date:
05/30/2012

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: 363LF0000X , with the licence number:  3015276 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 209022033 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: RN.315474 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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