1376645697 NPI number — MRS. REBECCA CLAIRE NORTHINGTON C.F.N.P.

Table of content: MRS. REBECCA CLAIRE NORTHINGTON C.F.N.P. (NPI 1376645697)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376645697 NPI number — MRS. REBECCA CLAIRE NORTHINGTON C.F.N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORTHINGTON
Provider First Name:
REBECCA
Provider Middle Name:
CLAIRE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
C.F.N.P.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STONE
Provider Other First Name:
REBECCA
Provider Other Middle Name:
CLAIRE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
C.F.N.P.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376645697
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 MAIN ST N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AMORY
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
38821-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-256-7114
Provider Business Mailing Address Fax Number:
662-256-7116

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 HOSPITAL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FULTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
38843-6002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-862-7047
Provider Business Practice Location Address Fax Number:
662-862-7053
Provider Enumeration Date:
09/05/2006

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:  R869970 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 500002258 . This is a "MS MEDICARE NO." identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 09354827 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".




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