1396015814 NPI number — MS. KATHY LIVINGSTON GUNTER CRNA

Table of content: MS. KATHY LIVINGSTON GUNTER CRNA (NPI 1396015814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396015814 NPI number — MS. KATHY LIVINGSTON GUNTER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUNTER
Provider First Name:
KATHY
Provider Middle Name:
LIVINGSTON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POLEWSKI
Provider Other First Name:
KATHY
Provider Other Middle Name:
MELINDA
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1396015814
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
526 TIMBERCHASE LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AIKEN
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-522-1291
Provider Business Mailing Address Fax Number:
803-648-2050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
526 TIMBERCHASE LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AIKEN
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-522-1291
Provider Business Practice Location Address Fax Number:
803-648-2050
Provider Enumeration Date:
01/02/2012

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: 367500000X , with the licence number:  APRN 17846 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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