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

Table of content: CAITLIN HARMON DO (NPI 1588240931)

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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