1962719849 NPI number — CASEY L. TURNBOUGH

Table of content: CASEY L. TURNBOUGH (NPI 1962719849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962719849 NPI number — CASEY L. TURNBOUGH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TURNBOUGH
Provider First Name:
CASEY
Provider Middle Name:
L.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TURNBOUGH
Provider Other First Name:
CASEY
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PMHNP-BC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962719849
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/24/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
620 W 1ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORTALES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88130-5928
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-226-3898
Provider Business Mailing Address Fax Number:
575-226-3890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
620 W 1ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORTALES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88130-5928
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-226-3898
Provider Business Practice Location Address Fax Number:
575-226-3890
Provider Enumeration Date:
09/13/2010

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: 363LP0808X , with the licence number:  CNP/01666 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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