1285026708 NPI number — KAREN KAY ISAACS CHW/CRS

Table of content: KAREN KAY ISAACS CHW/CRS (NPI 1285026708)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285026708 NPI number — KAREN KAY ISAACS CHW/CRS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ISAACS
Provider First Name:
KAREN
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CHW/CRS
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:
1285026708
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/19/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1514 CONWELL STREET
Provider Second Line Business Mailing Address:
208 WST 21ST STREET
Provider Business Mailing Address City Name:
CONNERSVILLE
Provider Business Mailing Address State Name:
INDIANA
Provider Business Mailing Address Postal Code:
47331
Provider Business Mailing Address Country Code:
UM
Provider Business Mailing Address Telephone Number:
765-338-9885
Provider Business Mailing Address Fax Number:
765-222-1249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 W 21ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONNERSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47331-2930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-338-9885
Provider Business Practice Location Address Fax Number:
765-222-1249
Provider Enumeration Date:
02/19/2015

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: 101YA0400X , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 111 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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