1548279052 NPI number — DEBBIE A FEEMSTER CRNA

Table of content: DEBBIE A FEEMSTER CRNA (NPI 1548279052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548279052 NPI number — DEBBIE A FEEMSTER CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FEEMSTER
Provider First Name:
DEBBIE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
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:
1548279052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1191 HIEATT LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SMITHFIELD
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40068-7900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1025 NEW MOODY LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-9154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-222-3886
Provider Business Practice Location Address Fax Number:
502-222-8647
Provider Enumeration Date:
08/05/2006

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: 367500000X , with the licence number:  1070055/1689A , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000000364688 . This is a "ANTHEM BCBS PAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000188238 . This is a "ANTHEM MIDWEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000000188238 . This is a "ANTHEM BCBS PAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1133797 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74346081 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com