1720388655 NPI number — KATHRYN ARNER NP

Table of content: KATHRYN ARNER NP (NPI 1720388655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720388655 NPI number — KATHRYN ARNER NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARNER
Provider First Name:
KATHRYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KIMBLE
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1720388655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9484
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02940-9484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-854-2508
Provider Business Mailing Address Fax Number:
401-854-2519

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
593 EDDY ST
Provider Second Line Business Practice Location Address:
CLAVERICK 2
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-4923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-854-2504
Provider Business Practice Location Address Fax Number:
401-854-2519
Provider Enumeration Date:
10/26/2010

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:  RN42174 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2100X , with the licence number: NP37585 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110087738A , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 939025129 . This is a "RI MEDICARE GROUP" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 02-25-2011 . This is a "BCBSRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 12-01-2010 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: 001971401 . This is a "RI MEDICARE" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".
  • Identifier: KA82976 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12-09-2010 . This is a "NHPRI" identifier , issued by the state of ( RI ) . This identifiers is of the category "OTHER".




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