1427143593 NPI number — PEARL KLOAC FNP

Table of content: PEARL KLOAC FNP (NPI 1427143593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427143593 NPI number — PEARL KLOAC FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLOAC
Provider First Name:
PEARL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
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:
1427143593
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HC 70 BOX 7397
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHONTO
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86054
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-672-3057
Provider Business Mailing Address Fax Number:
928-672-3062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
US HWY 98 & NAVAJO ROUTE 16
Provider Second Line Business Practice Location Address:
7397
Provider Business Practice Location Address City Name:
SHONTO
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-672-3000
Provider Business Practice Location Address Fax Number:
928-672-3062
Provider Enumeration Date:
10/04/2006

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: 363LF0000X , with the licence number:  4704119567 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 494458 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8HL079 . This is a "MEDICARE WR" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 8HL080 . This is a "MEDICARE CBQ" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com