1184789679 NPI number — DR. ROSEMARY KEHOE PEACHER PH.D.

Table of content: DR. ROSEMARY KEHOE PEACHER PH.D. (NPI 1184789679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184789679 NPI number — DR. ROSEMARY KEHOE PEACHER PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEACHER
Provider First Name:
ROSEMARY
Provider Middle Name:
KEHOE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
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:
1184789679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 413
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37077-0413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-826-0347
Provider Business Mailing Address Fax Number:
615-826-9147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
394 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE B9
Provider Business Practice Location Address City Name:
HENDERSONVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37075-3348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-826-0347
Provider Business Practice Location Address Fax Number:
615-826-9147
Provider Enumeration Date:
12/26/2006

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: 103TC0700X , with the licence number:  P2054 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 099705 . This is a "VALUE OPTIONS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3688866 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 44008 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1037001 . This is a "FIRST HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5184713 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1041311 . This is a "CIGNA BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4087226 . This is a "BLUE CROSS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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