1255686739 NPI number — KRISTIN SCENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255686739 NPI number — KRISTIN SCENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCENTER
Provider First Name:
KRISTIN
Provider Middle Name:
Provider Name Prefix Text:
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:
KEELE
Provider Other First Name:
KRISTIN
Provider Other Middle Name:
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:
1255686739
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO DRAWER 2109
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RUSSELLVILLE
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
479-967-2322
Provider Business Mailing Address Fax Number:
479-967-2876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 CHERI WHITLOCK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SILOAM SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72761-4220
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-524-2456
Provider Business Practice Location Address Fax Number:
479-373-1129
Provider Enumeration Date:
07/19/2012

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: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 209108721 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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