1477191062 NPI number — MR. JUSTIN DOUGLAS ATKINS MSN, RN, AGACNP-BC

Table of content: MR. JUSTIN DOUGLAS ATKINS MSN, RN, AGACNP-BC (NPI 1477191062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477191062 NPI number — MR. JUSTIN DOUGLAS ATKINS MSN, RN, AGACNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ATKINS
Provider First Name:
JUSTIN
Provider Middle Name:
DOUGLAS
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, AGACNP-BC
Provider Gender Code:
M

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:
1477191062
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
19431 VERBENA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APPLE VALLEY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92308-3347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-545-7996
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12740 HESPERIA RD STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VICTORVILLE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92395-8306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-998-1999
Provider Business Practice Location Address Fax Number:
760-881-3555
Provider Enumeration Date:
12/14/2019

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: 363LA2100X , with the licence number:  95013524 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 95013524 . This is a "CALIFORNIA BRN NP LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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