1356479927 NPI number — MS. KELLY WRAY NORD

Table of content: MS. KELLY WRAY NORD (NPI 1356479927)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356479927 NPI number — MS. KELLY WRAY NORD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORD
Provider First Name:
KELLY
Provider Middle Name:
WRAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICKETTS
Provider Other First Name:
KELLY
Provider Other Middle Name:
WRAY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1356479927
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
585 RIDGE RD.
Provider Second Line Business Mailing Address:
APT. D
Provider Business Mailing Address City Name:
ARCATA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-826-1329
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 WOOD ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EUREKA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-268-2990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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