1427665843 NPI number — ERICA MARIE QUARLES M.ED, LPATA

Table of content: ERICA MARIE QUARLES M.ED, LPATA (NPI 1427665843)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427665843 NPI number — ERICA MARIE QUARLES M.ED, LPATA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
QUARLES
Provider First Name:
ERICA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED, LPATA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MULLINS
Provider Other First Name:
ERICA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427665843
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9520 INDIAN PIPE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PROSPECT
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40059-7006
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-418-5849
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9520 INDIAN PIPE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PROSPECT
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40059-7006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-418-5849
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2020

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: 221700000X , with the licence number:  266152 , 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)





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