1831321447 NPI number — MS. MICHELE HUMEL ADKISSON

Table of content: MS. MICHELE HUMEL ADKISSON (NPI 1831321447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831321447 NPI number — MS. MICHELE HUMEL ADKISSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADKISSON
Provider First Name:
MICHELE
Provider Middle Name:
HUMEL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HUMEL
Provider Other First Name:
MICHELE
Provider Other Middle Name:
PRUITT
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1831321447
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6444 THORN RIDGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42420-8749
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-454-1047
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
170 ALAMEDA DE LAS PULGAS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REDWOOD CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94062-2751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-369-5811
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/14/2009

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: 242T00000X , with the licence number:  870129 , 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)