1336169465 NPI number — MRS. KIMBERLY H TOWLES OTR/L

Table of content: MRS. KIMBERLY H TOWLES OTR/L (NPI 1336169465)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336169465 NPI number — MRS. KIMBERLY H TOWLES OTR/L

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TOWLES
Provider First Name:
KIMBERLY
Provider Middle Name:
H
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR/L
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:
1336169465
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 7594
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKY MOUNT
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27804-0594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
252-443-0808
Provider Business Mailing Address Fax Number:
252-451-9032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 N BICKETT BLVD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
LOUISBURG
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27549-2178
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-497-8414
Provider Business Practice Location Address Fax Number:
919-497-8478
Provider Enumeration Date:
07/20/2006

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: 225X00000X , with the licence number:  1207 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 132VE . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7301578 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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