1992066559 NPI number — DEVONNA GILES MAGUET APRN

Table of content: DEVONNA GILES MAGUET APRN (NPI 1992066559)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992066559 NPI number — DEVONNA GILES MAGUET APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAGUET
Provider First Name:
DEVONNA
Provider Middle Name:
GILES
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:
DURHAM
Provider Other First Name:
DEVONNA
Provider Other Middle Name:
GILES
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1992066559
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
219 WOODCHASE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORBIN
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40701-8112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-521-5159
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
40 MOONBOW PLZ STE 1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORBIN
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40701-8983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-215-3488
Provider Business Practice Location Address Fax Number:
606-280-4015
Provider Enumeration Date:
05/30/2012

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:  3003233 , 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: K103140 . This is a "MEDICARE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 7100301900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00259 . This is a "MEDICARE PTAN ASSOCIATED WITH OFFICE NPI NUMBER 1386781789" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".




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