NPI |
1740596998 |
The first name of the provider, if the provider
is an individual. |
Entity Type Code |
1 |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider Last Name Legal Name |
PORTER |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider First Name |
AMBER |
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. |
Provider Middle Name |
L |
The second 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. |
Provider Credential Text |
RN |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider First Line Business Practice Location Address |
4430 MISSOURI AVE BLDG 310 |
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. |
Provider Business Practice Location Address City Name |
FORT LEONARD WOOD |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
MO |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
65473 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
5735961770 |
The telephone number associated with the location address of the provider being identified. |
Provider Business Practice Location Address Fax Number |
5735961797 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
8/26/2010 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
8/27/2018 |
The date that a record was last updated or changed. |
Provider Gender Code |
F |
The date that a record was last updated or changed. |
Healthcare Provider Taxonomy Code 1 |
163W00000X |
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 License Number 1 |
2014018613 |
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 License Number State Code 1 |
MO |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |