1740319136 NPI number — CASEY PEER NUTRITION CONSULTANTS

Table of content: (NPI 1740319136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740319136 NPI number — CASEY PEER NUTRITION CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CASEY PEER NUTRITION CONSULTANTS
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:
1740319136
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 MILAM CIRCLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-414-7491
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 MILAM CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-414-7491
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEER
Authorized Official First Name:
CASEY
Authorized Official Middle Name:
DRAKE
Authorized Official Title or Position:
REGISTERED DIETITIAN OWNER
Authorized Official Telephone Number:
865-414-7491

Provider Taxonomy Codes

  • Taxonomy code: 133V00000X , with the licence number:  1095 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00841 . This is a "DMRS WAIVER PROVIDER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com