1972668846 NPI number — KATHRYN R ADAMS CPNP

Table of content: KATHRYN R ADAMS CPNP (NPI 1972668846)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972668846 NPI number — KATHRYN R ADAMS CPNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
KATHRYN
Provider Middle Name:
R
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CPNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
JOHNSON
Provider Other First Name:
KATHRYN
Provider Other Middle Name:
R
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CPNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1972668846
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 UNIVERSITY AVE E
Provider Second Line Business Mailing Address:
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55101-2507
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-291-2848
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 UNIVERSITY AVE E
Provider Second Line Business Practice Location Address:
GILLETTE CHILDREN'S SPECIALTY HEALTHCARE
Provider Business Practice Location Address City Name:
SAINT PAUL
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55101-2507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-291-2848
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2006

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: 363LP0200X , with the licence number:  R130820-6 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1030454 . This is a "PREFERREDONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0585398 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 12-01624 . This is a "MEDICA - CHOICE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 171945 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43953500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0439647 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203A6JO . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 106602100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HP34896 . This is a "HEALTHPARTNERS" identifier . This identifiers is of the category "OTHER".




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