1184255069 NPI number — PAIGE ELIZABETH KINDLEY PHARMD

Table of content: PAIGE ELIZABETH KINDLEY PHARMD (NPI 1184255069)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184255069 NPI number — PAIGE ELIZABETH KINDLEY PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KINDLEY
Provider First Name:
PAIGE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VORTMAN
Provider Other First Name:
PAIGE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184255069
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 N E ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OSKALOOSA
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52577-2016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
641-673-3439
Provider Business Mailing Address Fax Number:
641-673-3945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
205 N E ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OSKALOOSA
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52577-2016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
641-673-3439
Provider Business Practice Location Address Fax Number:
641-673-3945
Provider Enumeration Date:
01/30/2020

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: 183500000X , with the licence number:  23372 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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