1124641709 NPI number — ANGELIC HANDS HOUSE CALLS

Table of content: MRS. CONSUELO K BREWER RPH, BCNSP (NPI 1962497701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124641709 NPI number — ANGELIC HANDS HOUSE CALLS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANGELIC HANDS HOUSE CALLS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1124641709
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 165
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANTON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39046-0165
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-906-0130
Provider Business Mailing Address Fax Number:
601-667-3508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
299 W PEACE ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CANTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39046-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-906-0130
Provider Business Practice Location Address Fax Number:
601-667-3508
Provider Enumeration Date:
05/18/2020

Additional Information

Authorized Official

Authorized Official Last Name:
JONES STEWART
Authorized Official First Name:
ANGELA
Authorized Official Middle Name:
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
601-906-0130

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 03820257 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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