1578036000 NPI number — CHARITY DARLENE PRIYADARSHI FNP

Table of content: CHARITY DARLENE PRIYADARSHI FNP (NPI 1578036000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578036000 NPI number — CHARITY DARLENE PRIYADARSHI FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRIYADARSHI
Provider First Name:
CHARITY
Provider Middle Name:
DARLENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEHMAN
Provider Other First Name:
CHARITY
Provider Other Middle Name:
DARLENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1578036000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
143 DEERFIELD MEADOW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77384-1405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-803-2465
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 DEERFIELD MEADOW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77384-1405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-803-2465
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/08/2019

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:  AP139510 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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