1861775314 NPI number — JERLENE LAMELLE WASHINGTON APN

Table of content: JERLENE LAMELLE WASHINGTON APN (NPI 1861775314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861775314 NPI number — JERLENE LAMELLE WASHINGTON APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WASHINGTON
Provider First Name:
JERLENE
Provider Middle Name:
LAMELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUTCHER
Provider Other First Name:
JERLENE
Provider Other Middle Name:
LAMELLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1861775314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7500 DOLLARWAY RD STE 105
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHITE HALL
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
71602-3082
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-247-2305
Provider Business Mailing Address Fax Number:
870-247-2330

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 DOLLARWAY RD STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITE HALL
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71602-3082
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-247-2305
Provider Business Practice Location Address Fax Number:
870-247-2330
Provider Enumeration Date:
09/21/2011

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: 101YM0800X , with the licence number:  A03529ANP , 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)





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