1528178621 NPI number — TIDEWATER INSTITUTE OF NLP

Table of content: (NPI 1528178621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528178621 NPI number — TIDEWATER INSTITUTE OF NLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TIDEWATER INSTITUTE OF NLP
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:
PRIVATE PRACTICE OF PAMELA JO KAYANAN
Provider Other Organization Name Type Code:
4
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:
1528178621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11747 JEFFERSON AVE
Provider Second Line Business Mailing Address:
SUITE 6D
Provider Business Mailing Address City Name:
NEWPORT NEWS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23606-1998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-643-8894
Provider Business Mailing Address Fax Number:
757-643-8914

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11747 JEFFERSON AVE
Provider Second Line Business Practice Location Address:
SUITE 6D
Provider Business Practice Location Address City Name:
NEWPORT NEWS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23606-1998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-643-8894
Provider Business Practice Location Address Fax Number:
757-643-8914
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KAYANAN
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
757-643-8894

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  0718000195 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 0701003183 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 0717001073 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 440869 . This is a "ANTHEM BCBS" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 2577110 . This is a "CAQH" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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