1720405095 NPI number — KRISTEN LUCELIA FLANNIGAN APCC

Table of content: KRISTEN LUCELIA FLANNIGAN APCC (NPI 1720405095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720405095 NPI number — KRISTEN LUCELIA FLANNIGAN APCC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLANNIGAN
Provider First Name:
KRISTEN
Provider Middle Name:
LUCELIA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APCC
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:
1720405095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 23070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BARLING
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72923-0070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21901 HORIZON CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEHACHAPI
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93561-9619
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-461-2037
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2014

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: 101YM0800X , with the licence number:  7667 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 7667 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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