1740552892 NPI number — MRS. MARY PATTON ARMSTRONG CNP

Table of content: MRS. MARY PATTON ARMSTRONG CNP (NPI 1740552892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740552892 NPI number — MRS. MARY PATTON ARMSTRONG CNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ARMSTRONG
Provider First Name:
MARY
Provider Middle Name:
PATTON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LINTNER
Provider Other First Name:
MARY
Provider Other Middle Name:
PATTON
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1740552892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/05/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
415 S 28TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HATTIESBURG
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39401-7246
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-579-5463
Provider Business Mailing Address Fax Number:
601-579-5240

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39429-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-736-8282
Provider Business Practice Location Address Fax Number:
601-736-8333
Provider Enumeration Date:
02/06/2012

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: 363LF0000X , with the licence number:  R883872 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 9972831 . This is a "AETNA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 08503773 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3424000 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 4970336 . This is a "CIGNA" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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