1255497855 NPI number — MS. KATHY S. MOSMAN NIGHBERT M.S., CCC-SLP

Table of content: MS. KATHY S. MOSMAN NIGHBERT M.S., CCC-SLP (NPI 1255497855)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255497855 NPI number — MS. KATHY S. MOSMAN NIGHBERT M.S., CCC-SLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NIGHBERT
Provider First Name:
KATHY
Provider Middle Name:
S. MOSMAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., CCC-SLP
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:
1255497855
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7200 MONTGOMERY BLVD NE
Provider Second Line Business Mailing Address:
#194
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-259-8140
Provider Business Mailing Address Fax Number:
505-883-2924

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 MONTGOMERY BLVD NE
Provider Second Line Business Practice Location Address:
#194
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-1510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-259-8140
Provider Business Practice Location Address Fax Number:
505-883-2924
Provider Enumeration Date:
12/28/2006

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: 235Z00000X , with the licence number:  3066 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 73920304 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 62725203 . This is a "DDW" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com