1417987157 NPI number — LORA L MEADOWS-KELTNER LPCC

Table of content: LORA L MEADOWS-KELTNER LPCC (NPI 1417987157)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417987157 NPI number — LORA L MEADOWS-KELTNER LPCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MEADOWS-KELTNER
Provider First Name:
LORA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCC
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:
1417987157
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1080
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURKESVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42717-1080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-858-6655
Provider Business Mailing Address Fax Number:
270-858-4027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 KIDS KORNER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENSBURG
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42743-1433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-435-0900
Provider Business Practice Location Address Fax Number:
270-858-4029
Provider Enumeration Date:
07/04/2006

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: 101YP2500X , with the licence number:  1053 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 11604741 . This is a "CAQH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 11604741 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100296750 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30605018 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com