1083057822 NPI number — MR. ALIN RAY KITCHENS JR. LMP

Table of content: MR. ALIN RAY KITCHENS JR. LMP (NPI 1083057822)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083057822 NPI number — MR. ALIN RAY KITCHENS JR. LMP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITCHENS
Provider First Name:
ALIN
Provider Middle Name:
RAY
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
LMP
Provider Gender Code:
M

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:
1083057822
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/16/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
231 SE BARRINGTON DR
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
OAK HARBOR
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98277-3200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-240-0808
Provider Business Mailing Address Fax Number:
866-240-0808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 STEWARD ROAD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MOUNT VERNON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98273
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-416-3322
Provider Business Practice Location Address Fax Number:
360-416-3302
Provider Enumeration Date:
04/11/2013

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: 225700000X , with the licence number:  MA60328543 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 103K00000X . This is a "L.E.A.P.S. AND BEYOND INC." identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com