1417428897 NPI number — MISS CHIARA JAMIEK OBEY

Table of content: MISS CHIARA JAMIEK OBEY (NPI 1417428897)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417428897 NPI number — MISS CHIARA JAMIEK OBEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OBEY
Provider First Name:
CHIARA
Provider Middle Name:
JAMIEK
Provider Name Prefix Text:
MISS
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:
1417428897
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
125 WASHITTA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAFAYETTE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70501-7755
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-706-6063
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2701 JOHNSTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70503-3263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-446-4707
Provider Business Practice Location Address Fax Number:
337-446-4715
Provider Enumeration Date:
12/11/2018

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)

  • Identifier: 640897031 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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