1578964011 NPI number — SHAYRIA RAICHELLE CATLIN DNP

Table of content: SHAYRIA RAICHELLE CATLIN DNP (NPI 1578964011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578964011 NPI number — SHAYRIA RAICHELLE CATLIN DNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CATLIN
Provider First Name:
SHAYRIA
Provider Middle Name:
RAICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCOVERY
Provider Other First Name:
SHAYRIA
Provider Other Middle Name:
RAICHELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578964011
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
251 N BAYOU ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36603-5827
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-690-8158
Provider Business Mailing Address Fax Number:
251-544-2188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5580 INN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36619-1904
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-666-7413
Provider Business Practice Location Address Fax Number:
251-666-7417
Provider Enumeration Date:
09/15/2014

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:  1-118258 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 011846 . This is a "MEDICARE GROUP PAYEE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 630000013 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063439065 . This is a "GROUP PAYEE NPI NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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