1811359524 NPI number — MRS. KAYLA ASHLEY NORMAN ADVANCED CASAC

Table of content: MRS. KAYLA ASHLEY NORMAN ADVANCED CASAC (NPI 1811359524)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811359524 NPI number — MRS. KAYLA ASHLEY NORMAN ADVANCED CASAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NORMAN
Provider First Name:
KAYLA
Provider Middle Name:
ASHLEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ADVANCED CASAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEYERBACH
Provider Other First Name:
KAYLA
Provider Other Middle Name:
ASHLEY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CASAC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1811359524
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
340 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HUDSON FALLS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-926-7200
Provider Business Mailing Address Fax Number:
518-747-8003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENS FALLS
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12801-4413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-747-8001
Provider Business Practice Location Address Fax Number:
518-747-8003
Provider Enumeration Date:
03/22/2016

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: 101YA0400X , with the licence number:  28315 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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