1295988483 NPI number — MS. KATI LYNN IVEY IDC

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 1295988483 NPI number — MS. KATI LYNN IVEY IDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IVEY
Provider First Name:
KATI
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
IDC
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:
1295988483
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/06/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
215 RAIN VALLEY CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEANSVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30256-5134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-231-7257
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PSC 814 BOX 19
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09865-0019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
011306972219335
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/31/2008

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: 1710I1002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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