1912551870 NPI number — SARAH J FAXON APRN

Table of content: SARAH J FAXON APRN (NPI 1912551870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912551870 NPI number — SARAH J FAXON APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FAXON
Provider First Name:
SARAH
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

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:
1912551870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/18/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1510
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47706-1510
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-450-6815
Provider Business Mailing Address Fax Number:
812-450-6822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
340 STARLITE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42420-6102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-215-3150
Provider Business Practice Location Address Fax Number:
812-858-2020
Provider Enumeration Date:
07/30/2019

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:  71009550A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 3011935 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 3011935 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 28254500A . This is a "RN LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 71009550A . This is a "APRN LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1114527 . This is a "RN LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: F11170196 . This is a "AANP CERTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3011935 . This is a "APRN LICENSE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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