1215640578 NPI number — MISS HAILEY ELIZABETH KLINE LGPC

Table of content: MISS HAILEY ELIZABETH KLINE LGPC (NPI 1215640578)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215640578 NPI number — MISS HAILEY ELIZABETH KLINE LGPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLINE
Provider First Name:
HAILEY
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
LGPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REED
Provider Other First Name:
HAILEY
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215640578
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
162 GREEENBRIDGE DRIVE
Provider Second Line Business Mailing Address:
APARTMENT C2
Provider Business Mailing Address City Name:
NEWARK
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-353-8705
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21921-5996
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-440-5790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2023

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: 101YM0800X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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