1083006191 NPI number — MS. KARLA JEAN DUKE ED.S. LPC/MHSP

Table of content: MS. KARLA JEAN DUKE ED.S. LPC/MHSP (NPI 1083006191)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083006191 NPI number — MS. KARLA JEAN DUKE ED.S. LPC/MHSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DUKE
Provider First Name:
KARLA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ED.S. LPC/MHSP
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:
1083006191
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2685
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COOKEVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38502-2685
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
931-303-7789
Provider Business Mailing Address Fax Number:
931-520-0767

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
441 E BROAD ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
COOKEVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38501-3389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-303-7789
Provider Business Practice Location Address Fax Number:
931-520-0767
Provider Enumeration Date:
02/26/2015

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 , with the licence number:  LPC0000003193 , registered in the state of TN ; 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