1912337619 NPI number — KEMETHER & ASSOCIATES, LLC

Table of content: KALATO LEHUE HOLTS FNP (NPI 1336501436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912337619 NPI number — KEMETHER & ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEMETHER & ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1912337619
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19 WOOD DUCK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELKTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21921-8021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-920-2309
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21921-5779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-920-2309
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/15/2013

Additional Information

Authorized Official

Authorized Official Last Name:
KEMETHER
Authorized Official First Name:
CARRIE
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
410-920-2309

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LC1716 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0602043 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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