1225147101 NPI number — KIMBERLY R FAUCHER MD

Table of content: KIMBERLY R FAUCHER MD (NPI 1225147101)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225147101 NPI number — KIMBERLY R FAUCHER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAUCHER
Provider First Name:
KIMBERLY
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1225147101
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1155 SOUTH MAIN STREET
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
WILLITS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-456-1100
Provider Business Mailing Address Fax Number:
707-456-1101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1155 SOUTH MAIN STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
WILLITS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95490
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-456-1100
Provider Business Practice Location Address Fax Number:
707-456-1101
Provider Enumeration Date:
08/30/2006

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: 207VG0400X , with the licence number:  G74987 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207VG0400X , with the licence number: MD00036004 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 4821FA . This is a "BLUE SHIELD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: 8232035 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0039592 . This is a "LABOR & INDUSTRY" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: US5553733 . This is a "AETNA/USHC SPECIALIST" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".
  • Identifier: P00239584 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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