1184982738 NPI number — MRS. SANDI KAY STURDIVANT PTA

Table of content: MRS. SANDI KAY STURDIVANT PTA (NPI 1184982738)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184982738 NPI number — MRS. SANDI KAY STURDIVANT PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STURDIVANT
Provider First Name:
SANDI
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GRAHAM
Provider Other First Name:
SANDI
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184982738
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2440
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOT SPRINGS
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71914-2440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-624-6468
Provider Business Mailing Address Fax Number:
501-624-1075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 CARSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOT SPRINGS NATIONAL PARK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71901-6852
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-624-6468
Provider Business Practice Location Address Fax Number:
501-624-1075
Provider Enumeration Date:
05/01/2012

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: 225200000X , with the licence number:  1792 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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