1629204953 NPI number — MS. KATHY WEBB KORDSMEIER M.S., LPEI

Table of content: MS. KATHY WEBB KORDSMEIER M.S., LPEI (NPI 1629204953)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629204953 NPI number — MS. KATHY WEBB KORDSMEIER M.S., LPEI

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KORDSMEIER
Provider First Name:
KATHY
Provider Middle Name:
WEBB
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S., LPEI
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:
1629204953
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7 PRIMROSE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBRIER
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72058-9116
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-269-1998
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 WOLFE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72202-5320
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-364-1830
Provider Business Practice Location Address Fax Number:
501-364-4931
Provider Enumeration Date:
06/01/2009

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: 174400000X , with the licence number:  83-35EI , 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)





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