| NPI |
1023602117 |
|
| Entity Type Code |
1 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
| Provider Last Name Legal Name |
PARIS |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Provider First Name |
REBECCA |
|
| Provider Middle Name |
IRENE |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
| Provider First Line Business Practice Location Address |
408 COLLEGE AVE |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
| Provider Business Practice Location Address City Name |
BLUEFIELD |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address State Name |
WV |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
| Provider Business Practice Location Address Postal Code |
247014643 |
|
| Provider Business Practice Location Address Country Code If outside U S |
US |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| Provider Business Practice Location Address Telephone Number |
3049222341 |
The telephone number associated with the location address of the provider being identified. |
| Provider Enumeration Date |
3/1/2021 |
The last name of the provider. If the provider is an individual, this is the legal name. |
| Last Update Date |
3/1/2021 |
The first name of the provider, if the provider
is an individual. |
| Provider Gender Code |
F |
The middle name of the provider, if the provider
is an individual. |
| Healthcare Provider Taxonomy Code 1 |
172V00000X |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Healthcare Provider Primary Taxonomy Switch 1 |
Y |
The city name in the location address of the provider being identified. |
| Is Sole Proprietor |
Y |
The State code in the location of the provider
being identified. |
| NPI Certification Date |
3/1/2021 |
|