1215167903 NPI number — MRS. YOLANDA GAIL SHIELDS CRT, AE-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215167903 NPI number — MRS. YOLANDA GAIL SHIELDS CRT, AE-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHIELDS
Provider First Name:
YOLANDA
Provider Middle Name:
GAIL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRT, AE-C
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:
1215167903
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
650 JOEL DR
Provider Second Line Business Mailing Address:
BLANCHFIELD ARMY COMMUNITY HOSPITAL
Provider Business Mailing Address City Name:
FORT CAMPBELL
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42223-5318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-956-0141
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
650 JOEL DR
Provider Second Line Business Practice Location Address:
BLANCHFIELD ARMY COMMUNITY HOSPITAL
Provider Business Practice Location Address City Name:
FORT CAMPBELL
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42223-5318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-956-0141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2009

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: 2278C0205X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2278E0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2278G1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2278P1006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2278E1000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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