1841330776 NPI number — AGAPE II

Table of content: KRISTEN LYNN WEIKEL CRNP (NPI 1568200079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841330776 NPI number — AGAPE II

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AGAPE II
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1841330776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 SKYWAY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28110-3007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-225-0584
Provider Business Mailing Address Fax Number:
704-225-1479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1008 GRIFFITH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28112-6241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
704-225-0584
Provider Business Practice Location Address Fax Number:
704-292-1915
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MASSEY
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRSIDENT
Authorized Official Telephone Number:
704-225-0584

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  MHL090073 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6604025 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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