1184726580 NPI number — AMY D RAPP PA

Table of content: AMY D RAPP PA (NPI 1184726580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184726580 NPI number — AMY D RAPP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RAPP
Provider First Name:
AMY
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WYATT
Provider Other First Name:
AMY
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184726580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2065 E SOUTH BLVD STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36116-2460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-747-7300
Provider Business Mailing Address Fax Number:
334-747-7320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2065 E SOUTH BLVD
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36116-2458
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-281-6990
Provider Business Practice Location Address Fax Number:
334-281-9725
Provider Enumeration Date:
09/05/2006

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: 363AS0400X , with the licence number:  PA120 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: WY000038256 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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