1669754016 NPI number — DR. ADRENNE JANETTE DEDEAUX PH.D

Table of content: DR. ADRENNE JANETTE DEDEAUX PH.D (NPI 1669754016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669754016 NPI number — DR. ADRENNE JANETTE DEDEAUX PH.D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEDEAUX
Provider First Name:
ADRENNE
Provider Middle Name:
JANETTE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D
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:
1669754016
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 E. WOODROW WILSON DR.
Provider Second Line Business Mailing Address:
VETERANS ADMINISTRATION MEDICAL CENTER
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-362-4471
Provider Business Mailing Address Fax Number:
601-364-1395

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 RIDGEWOOD ROAD
Provider Second Line Business Practice Location Address:
ADRENNE DEDEAUX
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-362-4471
Provider Business Practice Location Address Fax Number:
601-364-1395
Provider Enumeration Date:
09/12/2011

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com