1578547824 NPI number — KATHLEEN FINLEY

Table of content: KATHLEEN FINLEY (NPI 1578547824)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578547824 NPI number — KATHLEEN FINLEY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FINLEY
Provider First Name:
KATHLEEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FINLEY
Provider Other First Name:
KATHY
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1578547824
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 550
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE POINT
Provider Business Mailing Address State Name:
OR
Provider Business Mailing Address Postal Code:
97524-0550
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
541-830-0333
Provider Business Mailing Address Fax Number:
541-830-0863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21990 HWY 62
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHADY COVE
Provider Business Practice Location Address State Name:
OR
Provider Business Practice Location Address Postal Code:
97539-9717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-878-2022
Provider Business Practice Location Address Fax Number:
541-878-1498
Provider Enumeration Date:
11/30/2005

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: 363LF0000X , with the licence number:  000029650NP , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 117353 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com