1578155073 NPI number — CHERI PHELPS NESOM RN NURSE CASE MANAGE

Table of content: CHERI PHELPS NESOM RN NURSE CASE MANAGE (NPI 1578155073)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578155073 NPI number — CHERI PHELPS NESOM RN NURSE CASE MANAGE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NESOM
Provider First Name:
CHERI
Provider Middle Name:
PHELPS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN NURSE CASE MANAGE
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:
1578155073
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1585 3RD ST.,
Provider Second Line Business Mailing Address:
ATTENTION: CREDENTIALS ROOM
Provider Business Mailing Address City Name:
FT POLK
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
71459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-531-4253
Provider Business Mailing Address Fax Number:
337-531-4314

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1585 3RD STREET
Provider Second Line Business Practice Location Address:
ATTENTION: CREDENTIALS ROOM
Provider Business Practice Location Address City Name:
FT POLK
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71459-5102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-531-4253
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2021

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: 163WC0400X , with the licence number:  113770 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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