1336129022 NPI number — KATHRYN F LAUDERDALE APN

Table of content: KATHRYN F LAUDERDALE APN (NPI 1336129022)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336129022 NPI number — KATHRYN F LAUDERDALE APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAUDERDALE
Provider First Name:
KATHRYN
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1336129022
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 97
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GADSDEN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35902-0097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
256-492-0131
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4858 COUNTY ROAD 20
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERALDINE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
256-659-2422
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/19/2006

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: 363LF0000X , with the licence number:  12424 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 1-034313 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 78011228 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114058 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 113876 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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