1215589528 NPI number — MS. CARLOTTA SHAMBRE WESTMORELAND

Table of content: MS. CARLOTTA SHAMBRE WESTMORELAND (NPI 1215589528)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215589528 NPI number — MS. CARLOTTA SHAMBRE WESTMORELAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTMORELAND
Provider First Name:
CARLOTTA
Provider Middle Name:
SHAMBRE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JACKSON
Provider Other First Name:
CARLOTTA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215589528
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
482 HIGHWAY 32 E APT B
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRUCE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38915-9530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-927-0280
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
152 HIGHWAY 7 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38655-5392
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-234-7521
Provider Business Practice Location Address Fax Number:
662-236-3071
Provider Enumeration Date:
07/16/2019

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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