1518959139 NPI number — MRS. CATHY INGALLS WHNP

Table of content: MRS. CATHY INGALLS WHNP (NPI 1518959139)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518959139 NPI number — MRS. CATHY INGALLS WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
INGALLS
Provider First Name:
CATHY
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
WHNP
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:
1518959139
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6633 HWY 37
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PIERCE CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-354-8657
Provider Business Mailing Address Fax Number:
417-354-8607

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6633 HIGHWAY 37
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIERCE CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-354-8657
Provider Business Practice Location Address Fax Number:
417-354-8607
Provider Enumeration Date:
08/19/2005

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: 363LW0102X , with the licence number:  138054 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 425908506 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 425908522 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 425908514 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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