1982139721 NPI number — ANITA CHRISTINE MARTIN BYERS LPCA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982139721 NPI number — ANITA CHRISTINE MARTIN BYERS LPCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN BYERS
Provider First Name:
ANITA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPCA
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:
1982139721
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99036
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-277-0253
Provider Business Mailing Address Fax Number:
919-277-4627

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8368 SIX FORKS RD
Provider Second Line Business Practice Location Address:
SUITE NUMBER 101
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-277-0253
Provider Business Practice Location Address Fax Number:
919-277-4627
Provider Enumeration Date:
05/01/2017

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: 101YM0800X , with the licence number:  A12732 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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