1912139437 NPI number — CLARISSA JILL SEWELL ARNP

Table of content: KAYLA BAMBERG OTR/L (NPI 1508562448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912139437 NPI number — CLARISSA JILL SEWELL ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEWELL
Provider First Name:
CLARISSA
Provider Middle Name:
JILL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1912139437
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
800 ROSE STREET MARKEY CANCER CTR
Provider Second Line Business Mailing Address:
ROACH BUILDING, CC301
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40536-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-323-6792
Provider Business Mailing Address Fax Number:
859-323-8990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 ROSE STREET MARKEY CANCER CTR
Provider Second Line Business Practice Location Address:
ROACH BUILDING, CC301
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40536-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-323-6792
Provider Business Practice Location Address Fax Number:
859-323-8990
Provider Enumeration Date:
08/17/2009

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:  3001633 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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