1477167542 NPI number — KARA ADDISON DNP-C PLLC

Table of content: (NPI 1477167542)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477167542 NPI number — KARA ADDISON DNP-C PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARA ADDISON DNP-C PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1477167542
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 913239
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91110-3239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-820-3376
Provider Business Mailing Address Fax Number:
406-312-1611

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
920 FRONT ST STE 103
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HELENA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59601-3442
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-926-4691
Provider Business Practice Location Address Fax Number:
406-312-1611
Provider Enumeration Date:
09/04/2020

Additional Information

Authorized Official

Authorized Official Last Name:
HARRINGTON
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
406-926-4691

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 750624 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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