1205844479 NPI number — MRS. VERNA KATHLEEN SHIPP R.N., F.N.P.

Table of content: MRS. VERNA KATHLEEN SHIPP R.N., F.N.P. (NPI 1205844479)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205844479 NPI number — MRS. VERNA KATHLEEN SHIPP R.N., F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIPP
Provider First Name:
VERNA
Provider Middle Name:
KATHLEEN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
R.N., F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RAMSEY
Provider Other First Name:
VERNA
Provider Other Middle Name:
KATHLEEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
R.N., F.N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1205844479
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4004 82ND ST
Provider Second Line Business Mailing Address:
BUILDING 100
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79423-1900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-722-3180
Provider Business Mailing Address Fax Number:
806-722-3185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
919 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79316-4633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-637-2164
Provider Business Practice Location Address Fax Number:
806-637-4295
Provider Enumeration Date:
08/04/2006

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: 363LF0000X , with the licence number:  232618 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8Y0404 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 156196100 . This is a "TEAM CHOICE CORE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 156196100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7082814 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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