1689617649 NPI number — MRS. ANGELA D LYKINS PHD, HSPP

Table of content: MRS. ANGELA D LYKINS PHD, HSPP (NPI 1689617649)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689617649 NPI number — MRS. ANGELA D LYKINS PHD, HSPP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYKINS
Provider First Name:
ANGELA
Provider Middle Name:
D
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHD, HSPP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ARTHUR
Provider Other First Name:
ANGELA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD, HSPP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1689617649
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4221 N BROADWAY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47303-1015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-282-1750
Provider Business Mailing Address Fax Number:
765-282-9166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4221 N BROADWAY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MUNCIE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47303-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-282-1750
Provider Business Practice Location Address Fax Number:
765-282-9166
Provider Enumeration Date:
06/14/2006

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: 103TC0700X , with the licence number:  20040977 , 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)

  • Identifier: 000000181482 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200415280 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 084197000 . This is a "MAGELLAN HEALTH" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200081780 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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