1427899707 NPI number — MS. KORILYN CELEST BAUDOIN MSW

Table of content: MS. KORILYN CELEST BAUDOIN MSW (NPI 1427899707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427899707 NPI number — MS. KORILYN CELEST BAUDOIN MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUDOIN
Provider First Name:
KORILYN
Provider Middle Name:
CELEST
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1427899707
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3422 12TH ST APT A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GULFPORT
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39501-1600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-347-6077
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9414 THREE RIVERS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GULFPORT
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39503-4096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
228-305-0955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2024

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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