1194143255 NPI number — DUPREE MOBILE HEALTH CARE SERVICES

Table of content: MRS. JENNIFER LYNN NEVALA MPT (NPI 1295702389)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194143255 NPI number — DUPREE MOBILE HEALTH CARE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DUPREE MOBILE HEALTH CARE SERVICES
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1194143255
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 CHICK SPRINGS RD
Provider Second Line Business Mailing Address:
218E
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29609-4946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-325-4126
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 CHICK SPRINGS RD
Provider Second Line Business Practice Location Address:
218E
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29609-4946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-325-4126
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/04/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CHRISTINA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
864-325-4126

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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