1821299173 NPI number — TERRIE H PLATT CRNP

Table of content: TERRIE H PLATT CRNP (NPI 1821299173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821299173 NPI number — TERRIE H PLATT CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PLATT
Provider First Name:
TERRIE
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PLATT
Provider Other First Name:
TERRIE
Provider Other Middle Name:
H
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821299173
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 31
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATOM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36518-0031
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-242-1422
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
717 DOWNTOWNER LOOP W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36609-5503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
252-544-7077
Provider Business Practice Location Address Fax Number:
251-342-8999
Provider Enumeration Date:
05/31/2007

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: 363LX0001X , with the licence number:  1-122685 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP59651 , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102741000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com