1063296333 NPI number — KARA LYNETTE CARPENTER TREADWAY

Table of content: KARA LYNETTE CARPENTER TREADWAY (NPI 1063296333)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063296333 NPI number — KARA LYNETTE CARPENTER TREADWAY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARPENTER TREADWAY
Provider First Name:
KARA
Provider Middle Name:
LYNETTE
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:
TREADWAY
Provider Other First Name:
KARA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063296333
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4196 HIGHWAY 62 412 STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARDY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72542-8002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1702 MALCOLM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWPORT
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72112-3624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-495-7001
Provider Business Practice Location Address Fax Number:
870-495-7012
Provider Enumeration Date:
08/18/2023

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: 363LF0000X , with the licence number:  600068 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com