1558705848 NPI number — MS. KATHERINE BUTLER SWORDS PA-C

Table of content: MS. KATHERINE BUTLER SWORDS PA-C (NPI 1558705848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558705848 NPI number — MS. KATHERINE BUTLER SWORDS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWORDS
Provider First Name:
KATHERINE
Provider Middle Name:
BUTLER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1558705848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE SOUTH 350
Provider Business Mailing Address City Name:
MARRERO
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70072-3151
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-349-6350
Provider Business Mailing Address Fax Number:
504-349-6355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9320 PARK WEST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37923-4301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-373-7100
Provider Business Practice Location Address Fax Number:
504-349-6355
Provider Enumeration Date:
04/17/2013

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: 363A00000X , with the licence number:  PA.200610 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01188255 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: Q070212 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2379682 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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