1366570566 NPI number — DEBBIE KISS

Table of content: DEBBIE KISS (NPI 1366570566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366570566 NPI number — DEBBIE KISS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KISS
Provider First Name:
DEBBIE
Provider Middle Name:
Provider Name Prefix Text:
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:
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:
1366570566
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:
302 E. 24TH ST.
Provider Second Line Business Mailing Address:
P.O. BOX 4588
Provider Business Mailing Address City Name:
BRYAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77805-4588
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-822-6467
Provider Business Mailing Address Fax Number:
979-821-9448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3421 W DAVIS ST
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77304-1890
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-822-6467
Provider Business Practice Location Address Fax Number:
979-821-9448
Provider Enumeration Date:
03/01/2007

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: 225X00000X , with the licence number:  109356 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109356 . This is a "TEXAS LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com