1316967144 NPI number — MS. SUSAN MIRANDA PEOPLES FNP MSN

Table of content: MS. SUSAN MIRANDA PEOPLES FNP MSN (NPI 1316967144)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316967144 NPI number — MS. SUSAN MIRANDA PEOPLES FNP MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEOPLES
Provider First Name:
SUSAN
Provider Middle Name:
MIRANDA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MIRANDA
Provider Other First Name:
SUSAN
Provider Other Middle Name:
HELEN
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSN RN FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1316967144
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
609 DOUGLAS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-283-9234
Provider Business Mailing Address Fax Number:
423-975-2210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
219 PRINCETON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JOHNSON CITY
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37601-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-975-2200
Provider Business Practice Location Address Fax Number:
423-975-2210
Provider Enumeration Date:
07/21/2006

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: 163WG0000X , with the licence number:  RN 0000077907 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: APN 0000006292 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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