1720117773 NPI number — MRS. AIRNAGENE KATHERINE PREJEAN M.S.

Table of content: MRS. AIRNAGENE KATHERINE PREJEAN M.S. (NPI 1720117773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720117773 NPI number — MRS. AIRNAGENE KATHERINE PREJEAN M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PREJEAN
Provider First Name:
AIRNAGENE
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PREJEAN
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1720117773
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 MEADOW GLEN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
YOUNGSVILLE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70592-5331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-856-9258
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 DULLES DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70506-3008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-262-1226
Provider Business Practice Location Address Fax Number:
337-262-4183
Provider Enumeration Date:
03/05/2007

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com