1548749203 NPI number — KIMBERLY STAYTON RN

Table of content: KIMBERLY STAYTON RN (NPI 1548749203)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548749203 NPI number — KIMBERLY STAYTON RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STAYTON
Provider First Name:
KIMBERLY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
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:
1548749203
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/30/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6215 WAYNE WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSENBERG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77471-1911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-546-5955
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6719 TRINITY TRAIL LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77469-1952
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-546-5955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/13/2018

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WP0200X , with the licence number: 2001005289 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com