1841331683 NPI number — TWILA L PRESTON PHD

Table of content: (NPI 1285347047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841331683 NPI number — TWILA L PRESTON PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRESTON
Provider First Name:
TWILA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841331683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8014 STATE LINE RD
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
PRAIRIE VILLAGE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66208-3723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-432-2400
Provider Business Mailing Address Fax Number:
913-432-2401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8014 STATE LINE RD
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
PRAIRIE VILLAGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66208-3723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-432-2400
Provider Business Practice Location Address Fax Number:
913-432-2401
Provider Enumeration Date:
02/12/2007

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: 103TC0700X , with the licence number:  531 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 2241 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 74306484826 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 08406 . This is a "BCBSNE" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".




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