1992141642 NPI number — MRS. VERONICA KAY MUNDAY PLPC

Table of content: MRS. VERONICA KAY MUNDAY PLPC (NPI 1992141642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992141642 NPI number — MRS. VERONICA KAY MUNDAY PLPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MUNDAY
Provider First Name:
VERONICA
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PLPC
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:
1992141642
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 A SOUTH LAKE STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MTN GROVE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65711
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-234-1812
Provider Business Mailing Address Fax Number:
417-942-5238

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 A SOUTH LAKE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MTN GROVE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65711
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-234-1812
Provider Business Practice Location Address Fax Number:
417-942-5238
Provider Enumeration Date:
05/21/2013

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: 101YP2500X , 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)