1265058895 NPI number — MRS. KAILEY ELAINE FLOWERS PTA

Table of content: MRS. KAILEY ELAINE FLOWERS PTA (NPI 1265058895)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265058895 NPI number — MRS. KAILEY ELAINE FLOWERS PTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLOWERS
Provider First Name:
KAILEY
Provider Middle Name:
ELAINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCCALL
Provider Other First Name:
KAILEY
Provider Other Middle Name:
ELAINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265058895
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
305 NE LOOP 280
Provider Second Line Business Mailing Address:
BUSINESS TOWER 1, SUITE 200
Provider Business Mailing Address City Name:
HURST
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76053-0360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-292-8787
Provider Business Mailing Address Fax Number:
817-789-6849

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 EMPIRE CENTRAL DRIVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-364-8680
Provider Business Practice Location Address Fax Number:
855-275-2406
Provider Enumeration Date:
06/19/2020

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: 225200000X , with the licence number:  2153568 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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