1821134388 NPI number — DR. KARON B LYNN AUD

Table of content: DR. KARON B LYNN AUD (NPI 1821134388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821134388 NPI number — DR. KARON B LYNN AUD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LYNN
Provider First Name:
KARON
Provider Middle Name:
B
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD
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:
1821134388
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/19/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2700 S WOODLANDS VILLAGE BLVD
Provider Second Line Business Mailing Address:
SUITE 300-409
Provider Business Mailing Address City Name:
FLAGSTAFF
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86001-7114
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
928-522-0500
Provider Business Mailing Address Fax Number:
855-433-1122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 N RIM DR
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
FLAGSTAFF
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86001-3134
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-522-0500
Provider Business Practice Location Address Fax Number:
855-433-1122
Provider Enumeration Date:
01/30/2007

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: 231H00000X , with the licence number:  DA1156 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DA1156 . This is a "AUDIOLOGY LICENSE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".




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