1578971263 NPI number — MRS. WINDY MICHELLE DEMOURA APRN

Table of content: MRS. WINDY MICHELLE DEMOURA APRN (NPI 1578971263)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578971263 NPI number — MRS. WINDY MICHELLE DEMOURA APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMOURA
Provider First Name:
WINDY
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MRS.
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:
1578971263
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 746725
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-6725
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-533-7017
Provider Business Mailing Address Fax Number:
601-533-7016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4221 ASHEVILLE HWY
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:
37914-3508
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-392-7264
Provider Business Practice Location Address Fax Number:
858-516-5891
Provider Enumeration Date:
07/26/2014

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:  APRN9385696 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 18914 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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