1427306000 NPI number — MISS AMBER DAWN BROYLES BA

Table of content: MISS AMBER DAWN BROYLES BA (NPI 1427306000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427306000 NPI number — MISS AMBER DAWN BROYLES BA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROYLES
Provider First Name:
AMBER
Provider Middle Name:
DAWN
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
BA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TABOR
Provider Other First Name:
AMBER
Provider Other Middle Name:
DAWN
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427306000
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 W CADDO ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74020-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
918-308-5511
Provider Business Mailing Address Fax Number:
918-205-2701

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 W CADDO ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74020-4201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-308-5511
Provider Business Practice Location Address Fax Number:
918-205-2701
Provider Enumeration Date:
08/29/2012

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: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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