1306979570 NPI number — DR. KATHLEEN DUNN FARR MD

Table of content: DR. KATHLEEN DUNN FARR MD (NPI 1306979570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306979570 NPI number — DR. KATHLEEN DUNN FARR MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARR
Provider First Name:
KATHLEEN
Provider Middle Name:
DUNN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DUNN
Provider Other First Name:
KATHLEEN
Provider Other Middle Name:
ANNE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1306979570
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2817 REILLY ROAD ATTN MCXC-COD CREDENTIALS
Provider Second Line Business Mailing Address:
WOMACK ARMY MEDICAL CENTER, STOP A
Provider Business Mailing Address City Name:
FORT BRAGG
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28310-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-907-8922
Provider Business Mailing Address Fax Number:
910-907-6069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JSOMTC USAJFKSWCS
Provider Second Line Business Practice Location Address:
2175 REILLY ROAD, STOP A
Provider Business Practice Location Address City Name:
FORT BRAGG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28310-5000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-396-5911
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/14/2007

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: 208000000X , with the licence number:  32491 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2083P0901X , with the licence number: 32491 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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