1154705689 NPI number — LINDSY LAURA KRAGT ALLEN D.P.M.

Table of content: LINDSY LAURA KRAGT ALLEN D.P.M. (NPI 1154705689)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154705689 NPI number — LINDSY LAURA KRAGT ALLEN D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEN
Provider First Name:
LINDSY
Provider Middle Name:
LAURA KRAGT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KRAGT
Provider Other First Name:
LINDSY
Provider Other Middle Name:
LAURA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1154705689
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/29/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 RIVERGATE UNIT 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DURANGO
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81301-7490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-717-7346
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1608 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-395-9575
Provider Business Practice Location Address Fax Number:
505-466-5166
Provider Enumeration Date:
07/14/2015

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: 213ES0103X , with the licence number:  POD413 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 213ES0103X , with the licence number: SC006691 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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