1952548471 NPI number — MS. KRISTINA BURROW WOODRUFF M.A., ATR-BC,LPAT

Table of content: MS. KRISTINA BURROW WOODRUFF M.A., ATR-BC,LPAT (NPI 1952548471)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952548471 NPI number — MS. KRISTINA BURROW WOODRUFF M.A., ATR-BC,LPAT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOODRUFF
Provider First Name:
KRISTINA
Provider Middle Name:
BURROW
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., ATR-BC,LPAT
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:
1952548471
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
111 PRESCOTT RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39110-4726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-201-1515
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 PARK CIRCLE DR
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
FLOWOOD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39232-7628
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-664-0455
Provider Business Practice Location Address Fax Number:
601-664-1675
Provider Enumeration Date:
01/21/2009

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: 221700000X , with the licence number:  PAT0006 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: PAT0006 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101Y00000X , with the licence number: PAT0006 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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