1548789209 NPI number — MRS. JOANNA SCHREIT KO RN BSN APRN FNP

Table of content: MRS. JOANNA SCHREIT KO RN BSN APRN FNP (NPI 1548789209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548789209 NPI number — MRS. JOANNA SCHREIT KO RN BSN APRN FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KO
Provider First Name:
JOANNA
Provider Middle Name:
SCHREIT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN BSN APRN FNP
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:
1548789209
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 W KINGSHIGHWAY STE 14
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARAGOULD
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72450-4197
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-239-8591
Provider Business Mailing Address Fax Number:
870-239-8137

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4000 LINWOOD DR STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARAGOULD
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72450-7224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-239-8268
Provider Business Practice Location Address Fax Number:
870-239-8277
Provider Enumeration Date:
09/13/2017

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: 363LF0000X , with the licence number:  A005208 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 225774758 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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