1831161215 NPI number — KATHREEN D THESSING RNP

Table of content: MR. EDWARD MONROE COURTNEY JR. MPT (NPI 1265703557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831161215 NPI number — KATHREEN D THESSING RNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THESSING
Provider First Name:
KATHREEN
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THESSING
Provider Other First Name:
KATHY
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831161215
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32 LAVER CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-455-0255
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11321 INTERSTATE 30
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-455-4700
Provider Business Practice Location Address Fax Number:
501-455-9044
Provider Enumeration Date:
02/01/2006

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: 363L00000X , with the licence number:  P01571 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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