1295994630 NPI number — MRS. MARY BETH NORSWORTHY CPTA

Table of content: MRS. MARY BETH NORSWORTHY CPTA (NPI 1295994630)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295994630 NPI number — MRS. MARY BETH NORSWORTHY CPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORSWORTHY
Provider First Name:
MARY BETH
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREATHOUSE
Provider Other First Name:
MARY BETH
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPTA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1295994630
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8118 NW FOREST DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEATHERBY LAKE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64152-1652
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-694-4423
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 ANTIOCH RD
Provider Second Line Business Practice Location Address:
SUITE 430
Provider Business Practice Location Address City Name:
MERRIAM
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-1258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-652-9229
Provider Business Practice Location Address Fax Number:
913-652-9198
Provider Enumeration Date:
06/02/2008

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:  2000152520 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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