1568892420 NPI number — MRS. KRISTIN NICOLE CARR P.T.A.

Table of content: MRS. KRISTIN NICOLE CARR P.T.A. (NPI 1568892420)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568892420 NPI number — MRS. KRISTIN NICOLE CARR P.T.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARR
Provider First Name:
KRISTIN
Provider Middle Name:
NICOLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
P.T.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HOLLOWAY
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
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:
1568892420
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2050 KEOKUK WASHINGTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KEOTA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52248-9200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-461-1233
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 S MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRFIELD
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52556-9572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-469-4353
Provider Business Practice Location Address Fax Number:
641-469-4288
Provider Enumeration Date:
11/13/2013

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: 225200000X , with the licence number:  005078 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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