1134237647 NPI number — KARIN RINER WILCOX-IRVIN LPC

Table of content: KARIN RINER WILCOX-IRVIN LPC (NPI 1134237647)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134237647 NPI number — KARIN RINER WILCOX-IRVIN LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILCOX-IRVIN
Provider First Name:
KARIN
Provider Middle Name:
RINER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
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:
1134237647
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
505 AMITY RD
Provider Second Line Business Mailing Address:
SUITE 608
Provider Business Mailing Address City Name:
CONWAY
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72032-5964
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-205-0253
Provider Business Mailing Address Fax Number:
501-205-0253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
505 AMITY RD
Provider Second Line Business Practice Location Address:
SUITE 608
Provider Business Practice Location Address City Name:
CONWAY
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72032-5964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-205-0253
Provider Business Practice Location Address Fax Number:
501-205-0253
Provider Enumeration Date:
08/25/2006

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: 101YP2500X , with the licence number:  P0805042 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YM0800X , with the licence number: P0805042 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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