1942692124 NPI number — KATHERINA TAYLOR CHAPPELL PA-C, MPA

Table of content: KATHERINA TAYLOR CHAPPELL PA-C, MPA (NPI 1942692124)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942692124 NPI number — KATHERINA TAYLOR CHAPPELL PA-C, MPA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHAPPELL
Provider First Name:
KATHERINA
Provider Middle Name:
TAYLOR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C, MPA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WARD
Provider Other First Name:
KATIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C, MPA
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942692124
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
975 RYLAND ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-1667
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-982-5000
Provider Business Mailing Address Fax Number:
775-982-5225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
780 KUENZLI ST
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-0845
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-982-4590
Provider Business Practice Location Address Fax Number:
775-982-4595
Provider Enumeration Date:
02/25/2015

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: 363A00000X , with the licence number:  PA1607 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: PA1607 . This is a "PA-C LICENSE" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 13543525 . This is a "CAQH" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".




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