1164738951 NPI number — KARA D MESCHKO APRN

Table of content: KARA D MESCHKO APRN (NPI 1164738951)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164738951 NPI number — KARA D MESCHKO APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESCHKO
Provider First Name:
KARA
Provider Middle Name:
D
Provider Name Prefix Text:
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:
HAYNES
Provider Other First Name:
KARA
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164738951
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/16/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 JOSHUA LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HAWESVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2211 MAYFAIR DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
OWENSBORO
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42301-4568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-688-1352
Provider Business Practice Location Address Fax Number:
270-688-4313
Provider Enumeration Date:
08/31/2010

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:  3006600 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100133940 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201044500 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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