1073626685 NPI number — KATHRYN ANN GLYNN AU.D. CCC-A

Table of content: KATHRYN ANN GLYNN AU.D. CCC-A (NPI 1073626685)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073626685 NPI number — KATHRYN ANN GLYNN AU.D. CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLYNN
Provider First Name:
KATHRYN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AU.D. CCC-A
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:
1073626685
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 WALDEN RIDGE DR STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28803-8591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-654-9299
Provider Business Mailing Address Fax Number:
828-654-9266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7 WALDEN RIDGE DR STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28803-8591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-654-9299
Provider Business Practice Location Address Fax Number:
828-654-9266
Provider Enumeration Date:
08/16/2006

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: 231H00000X , with the licence number:  10946 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 640C710440 . This is a "BCBS" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 40-4683793 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: KG000088 . This is a "LICENSE NUMBER" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 10946 . This is a "NC AUDIOLOGY LICENSE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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