1811548894 NPI number — CATINA LOUISE ANDERSON A-GNP -C

Table of content: CATINA LOUISE ANDERSON A-GNP -C (NPI 1811548894)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811548894 NPI number — CATINA LOUISE ANDERSON A-GNP -C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CATINA
Provider Middle Name:
LOUISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
A-GNP -C
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:
1811548894
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
50 S B B KING BLVD # 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38103-2626
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-436-1381
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 S 29TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHICKASHA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73018-2501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-896-8058
Provider Business Practice Location Address Fax Number:
855-223-1999
Provider Enumeration Date:
09/22/2019

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: 363LA2200X , with the licence number:  R0064950 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1811548894 . This is a "NPI" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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