1467137109 NPI number — BLOOM THERAPEUTICS PLLC

Table of content: MS. KATHERINE GAYNELL GARRISON CRNA (NPI 1649520446)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467137109 NPI number — BLOOM THERAPEUTICS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BLOOM THERAPEUTICS PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1467137109
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 W ACADEMY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHEBORO
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27203-5648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
336-596-6283
Provider Business Mailing Address Fax Number:
336-628-0111

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
131 W ACADEMY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ASHEBORO
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27203-5648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
336-596-6283
Provider Business Practice Location Address Fax Number:
336-628-0111
Provider Enumeration Date:
06/20/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COLE
Authorized Official First Name:
BROOKLYNN
Authorized Official Middle Name:
COGGINS
Authorized Official Title or Position:
THERAPIST
Authorized Official Telephone Number:
336-596-6283

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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