1023438314 NPI number — MRS. PRISCILLA RAYBURN DIPASQUALE M.S.

Table of content: MRS. PRISCILLA RAYBURN DIPASQUALE M.S. (NPI 1023438314)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023438314 NPI number — MRS. PRISCILLA RAYBURN DIPASQUALE M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIPASQUALE
Provider First Name:
PRISCILLA
Provider Middle Name:
RAYBURN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.
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:
1023438314
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12217 FARLEY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66213-1686
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-481-3136
Provider Business Mailing Address Fax Number:
888-652-9198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6700 ANTIOCH RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
MERRIAM
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66204-1497
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-652-9229
Provider Business Practice Location Address Fax Number:
888-652-9198
Provider Enumeration Date:
04/24/2014

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: 235Z00000X , with the licence number:  243 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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