1679993877 NPI number — MRS. KERI LYNN WIMBERLY-BROWN MS, LCAC, CADAC IV

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679993877 NPI number — MRS. KERI LYNN WIMBERLY-BROWN MS, LCAC, CADAC IV

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WIMBERLY-BROWN
Provider First Name:
KERI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS, LCAC, CADAC IV
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WIMBERLY
Provider Other First Name:
KERI
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LCAC, CADAC IV
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1679993877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2575 CHASEWAY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46268-1285
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-908-6624
Provider Business Mailing Address Fax Number:
317-641-0434

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2575 CHASEWAY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46268-1285
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-908-6624
Provider Business Practice Location Address Fax Number:
317-641-0434
Provider Enumeration Date:
04/27/2014

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: 101YA0400X , with the licence number:  87001136A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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