1952302747 NPI number — MS. KATHRYN LOSHARON YOUNG FNPC

Table of content: MS. KATHRYN LOSHARON YOUNG FNPC (NPI 1952302747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952302747 NPI number — MS. KATHRYN LOSHARON YOUNG FNPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
YOUNG
Provider First Name:
KATHRYN
Provider Middle Name:
LOSHARON
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNPC
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:
1952302747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 723
Provider Second Line Business Mailing Address:
980 MAIN ST.
Provider Business Mailing Address City Name:
FAIRPLAY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80440-0723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-836-3455
Provider Business Mailing Address Fax Number:
719-836-1792

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
980 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAIRPLAY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80440-0723
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-836-3455
Provider Business Practice Location Address Fax Number:
719-836-1792
Provider Enumeration Date:
08/03/2005

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: 363LF0000X , with the licence number:  43262 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 07100753 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: YO634320 . This is a "BLUE CROSS" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 841202560-01 . This is a "CO PACIFICARE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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