1649576455 NPI number — MRS. ERIN ELAINE FARKAS APRN

Table of content: (NPI 1497830996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649576455 NPI number — MRS. ERIN ELAINE FARKAS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARKAS
Provider First Name:
ERIN
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIS
Provider Other First Name:
ERIN
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649576455
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
545 DARE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT STERLING
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40353-9341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-274-3586
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
401 COMMERCE CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40353-7815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-498-5243
Provider Business Practice Location Address Fax Number:
859-498-5396
Provider Enumeration Date:
01/27/2011

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: 363LP0200X , with the licence number:  3006588 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X , with the licence number: AC001365 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 3006588 . This is a "KY APRN" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: AC001365 . This is a "MARYLAND APRN LINCESE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 7100152740 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111202500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com