1659676526 NPI number — ERIN LEIGH LARKINS ACNP

Table of content: ERIN LEIGH LARKINS ACNP (NPI 1659676526)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659676526 NPI number — ERIN LEIGH LARKINS ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LARKINS
Provider First Name:
ERIN
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BELL
Provider Other First Name:
ERIN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
ACNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659676526
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CLINIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISONVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42431-1661
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 HOSPITAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MADISONVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42431-1658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-326-3800
Provider Business Practice Location Address Fax Number:
270-326-3805
Provider Enumeration Date:
01/24/2011

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: 363LA2100X , with the licence number:  50105 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: P00976745 . This is a "RR MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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