1144228990 NPI number — MISS JESSICA LYNN KIRCHNER PT

Table of content: MISS JESSICA LYNN KIRCHNER PT (NPI 1144228990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144228990 NPI number — MISS JESSICA LYNN KIRCHNER PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIRCHNER
Provider First Name:
JESSICA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1144228990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10201 ARCOS AVE
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
ESTERO
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33928-9459
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-425-6909
Provider Business Mailing Address Fax Number:
239-992-4589

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10201 ARCOS AVE
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
ESTERO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33928-9459
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-425-6909
Provider Business Practice Location Address Fax Number:
239-992-4589
Provider Enumeration Date:
07/14/2005

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: 2251X0800X , with the licence number:  23271 , 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)