1699005504 NPI number — MRS. SUMMER DUNCAN TEMPLETON CRNA

Table of content: BRYNN MAYS LCSW (NPI 1265248355)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699005504 NPI number — MRS. SUMMER DUNCAN TEMPLETON CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEMPLETON
Provider First Name:
SUMMER
Provider Middle Name:
DUNCAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUNCAN
Provider Other First Name:
SUMMER
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1699005504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13523 BARRETT PARKWAY DRIVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
BALLWIN
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63102
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-938-6868
Provider Business Mailing Address Fax Number:
636-938-1486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1757 IMPERIAL BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CHARLES
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-310-2832
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2009

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: 367500000X , with the licence number:  714011 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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