1922209626 NPI number — MRS. KATHARINE JOYCE NEVILLE PT

Table of content: MRS. KATHARINE JOYCE NEVILLE PT (NPI 1922209626)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922209626 NPI number — MRS. KATHARINE JOYCE NEVILLE PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEVILLE
Provider First Name:
KATHARINE
Provider Middle Name:
JOYCE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEHMANN
Provider Other First Name:
KATHARINE
Provider Other Middle Name:
JOYCE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1922209626
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/29/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6 PALISADES VIEW COURT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EUREKA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-938-6650
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
70 E NORTH ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63025-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-938-4065
Provider Business Practice Location Address Fax Number:
636-938-4067
Provider Enumeration Date:
05/30/2007

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: 225100000X , with the licence number:  2002006962 , 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)





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