1972626315 NPI number — MRS. APRIL ANN MUNGLE OTRL

Table of content: KYLEE GOODWIN DPT (NPI 1093229023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972626315 NPI number — MRS. APRIL ANN MUNGLE OTRL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNGLE
Provider First Name:
APRIL
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTRL
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENNETT
Provider Other First Name:
APRIL
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972626315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11 FRONTERA CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS VILLAGE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71909-3013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-922-3350
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 NORTH HIGHWAY 7
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JESSIEVILLE
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-984-5665
Provider Business Practice Location Address Fax Number:
501-984-4200
Provider Enumeration Date:
04/09/2007

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: 225XP0200X , with the licence number:  OTR1403 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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