1215294764 NPI number — MRS. KAY SHAW THRASH CRNP

Table of content: MRS. KAY SHAW THRASH CRNP (NPI 1215294764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215294764 NPI number — MRS. KAY SHAW THRASH CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THRASH
Provider First Name:
KAY
Provider Middle Name:
SHAW
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CRNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SHAW THRASH
Provider Other First Name:
MARY
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
CRNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1215294764
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 LOWELL DR SE
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
HUNTSVILLE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35801-3754
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-535-5944
Provider Business Mailing Address Fax Number:
256-535-5959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 LOWELL DR SE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
HUNTSVILLE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35801-3754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-535-5944
Provider Business Practice Location Address Fax Number:
256-535-5959
Provider Enumeration Date:
04/20/2012

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: 363LX0001X , with the licence number:  1-025143 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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