1114780400 NPI number — MRS. KATHERINE CHRISTINE OPPS APRN

Table of content: MRS. KATHERINE CHRISTINE OPPS APRN (NPI 1114780400)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114780400 NPI number — MRS. KATHERINE CHRISTINE OPPS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OPPS
Provider First Name:
KATHERINE
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RODMAN
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1114780400
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 947407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30394-7407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-917-2600
Provider Business Mailing Address Fax Number:
941-917-7884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14405 ARBOR GREEN TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKEWOOD RANCH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34202-8409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-917-7080
Provider Business Practice Location Address Fax Number:
941-917-7085
Provider Enumeration Date:
01/31/2024

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:  APRN11030897 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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