1861461071 NPI number — KATHI A LUTZ RN, FNP

Table of content: KATHI A LUTZ RN, FNP (NPI 1861461071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861461071 NPI number — KATHI A LUTZ RN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUTZ
Provider First Name:
KATHI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN, FNP
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:
1861461071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1605 E BROADWAY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65201-8023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-256-7700
Provider Business Mailing Address Fax Number:
573-256-3004

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1605 E BROADWAY STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-8023
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-256-7700
Provider Business Practice Location Address Fax Number:
573-256-3003
Provider Enumeration Date:
03/17/2006

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: 363L00000X , with the licence number:  093278 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 423927805 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".