1457719221 NPI number — KIERSTEN LIGHT PROCHNOW LPC

Table of content: KIERSTEN LIGHT PROCHNOW LPC (NPI 1457719221)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457719221 NPI number — KIERSTEN LIGHT PROCHNOW LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PROCHNOW
Provider First Name:
KIERSTEN
Provider Middle Name:
LIGHT
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIGHT
Provider Other First Name:
KIERSTEN
Provider Other Middle Name:
CLARE
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:
1457719221
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 E. PALM VALLEY BLVD., UNIT 112
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78665
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
318-655-8265
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 TAYLOR ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUTTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-398-0945
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2016

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: 101Y00000X , with the licence number:  PLC6588 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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