1871115436 NPI number — KEMPCARE INC.

Table of content: KAREN NADINE STANLEY NP (NPI 1265125132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871115436 NPI number — KEMPCARE INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KEMPCARE INC.
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:
1871115436
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
840 US HIGHWAY 1 STE 435C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
N PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33408-3829
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-294-7741
Provider Business Mailing Address Fax Number:
561-805-1097

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 US HIGHWAY 1 STE 435C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
N PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33408-3829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-294-7741
Provider Business Practice Location Address Fax Number:
561-805-1097
Provider Enumeration Date:
05/17/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SUTHERLAND
Authorized Official First Name:
AYANNA
Authorized Official Middle Name:
BABCOCK
Authorized Official Title or Position:
CEO/FOUNDER
Authorized Official Telephone Number:
561-294-7741

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0108130000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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