1558022665 NPI number — BETTY ANN DOBBS APRN

Table of content: BETTY ANN DOBBS APRN (NPI 1558022665)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558022665 NPI number — BETTY ANN DOBBS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOBBS
Provider First Name:
BETTY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
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:
1558022665
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1030 WEST MAIN ST
Provider Second Line Business Mailing Address:
268 PENDERVILLE RD WEIR, MS 39772 (HOME ADDRESS)
Provider Business Mailing Address City Name:
ACKERMAN
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39735
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
662-285-3239
Provider Business Mailing Address Fax Number:
662-285-3210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1030 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ACKERMAN
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
662-705-3239
Provider Business Practice Location Address Fax Number:
662-705-8795
Provider Enumeration Date:
01/02/2022

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: 363LC1500X , with the licence number:  905147 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 905147 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: 905147 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163W00000X , with the licence number: R876207 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WC1500X , with the licence number: R876207 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 905147 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com