1972973113 NPI number — MRS. CASSIDY RAE CHATHAM JOHNS N.P

Table of content: MRS. CASSIDY RAE CHATHAM JOHNS N.P (NPI 1972973113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972973113 NPI number — MRS. CASSIDY RAE CHATHAM JOHNS N.P

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNS
Provider First Name:
CASSIDY
Provider Middle Name:
RAE CHATHAM
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
N.P
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHATHAM
Provider Other First Name:
CASSIDY
Provider Other Middle Name:
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:
1972973113
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2217 MISTLE THRUSH DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH LAS VEGAS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89084-2223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-220-8686
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6900 N DURANGO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS VEGAS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89149-4409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-835-9700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2015

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: 363LA2100X , with the licence number:  TAP8189 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: TAP8190 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: APRN002586 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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