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SHANE BRATCHER
Complete NPI Record 1578045506
Speech-Language Pathologist in Farmington, NM

NPI Status: Active since September 06, 2018

Contact Information

5840 FORTUNA DR
FARMINGTON, NM
ZIP 87402
Phone: (505) 599-8625

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Table of Contents

  1. NPI
  2. Entity Type Code
  3. Provider Last Name Legal Name
  4. Provider First Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Provider Gender Code
  20. Healthcare Provider Taxonomy Code 1
  21. Provider License Number 1
  22. Provider License Number State Code 1
  23. Healthcare Provider Primary Taxonomy Switch 1
  24. Is Sole Proprietor

Complete NPI Dataset

This page represents the complete record for NPI 1578045506. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1578045506
The country code in the location address of the provider being identified.
Entity Type Code: 1
The telephone number associated with the location address of the provider being identified.
The fax number associated with the location address of the provider being identified.
Provider First Name: SHANE
The date the provider was assigned a unique identifier (assigned an NPI).
Provider First Line Business Mailing Address: 5840 FORTUNA DR
The date that a record was last updated or changed.
Provider Business Mailing Address City Name: FARMINGTON
The city name in the mailing address of the provider being identified.
Provider Business Mailing Address State Name: NM
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Business Mailing Address Postal Code: 874028210
The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 5055998625
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 5840 FORTUNA DR
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: FARMINGTON
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NM
The State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code: 874028210
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: 5055998625
The telephone number associated with the location address of the provider being identified.
Provider Enumeration Date: 9/6/2018
The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date: 9/6/2018
The date that a record was last updated or changed.
Provider Gender Code: M
The code designating the provider’s gender if the provider is a person.
Healthcare Provider Taxonomy Code 1: 235Z00000X
The country code in the location address of the provider being identified.
Provider License Number 1: CF6493
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’’.
Provider License Number State Code 1: NM
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
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