1972639201 NPI number — DR. KIMBERLY A HALSEY A.P.,D.O.M.

Table of content: DR. KIMBERLY A HALSEY A.P.,D.O.M. (NPI 1972639201)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972639201 NPI number — DR. KIMBERLY A HALSEY A.P.,D.O.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALSEY
Provider First Name:
KIMBERLY
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
A.P.,D.O.M.
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:
1972639201
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:
6149 SAPPHIRE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34653-2539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-505-4574
Provider Business Mailing Address Fax Number:
727-841-7470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8811 STATE ROAD 52
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUDSON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34667-6784
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-666-0933
Provider Business Practice Location Address Fax Number:
352-666-0934
Provider Enumeration Date:
02/23/2007

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: 171100000X , with the licence number:  AP2212 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 205617801 . This is a "TAX IDENTIFICATION" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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