Healthcare Provider Details

I. General information

NPI: 1891910675
Provider Name (Legal Business Name): HUMBOLDT UNIFIED SCHOOL DISTRICT #22
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8766 E HWY 69 ATTN DONNA THAXTON SPECIAL SERVICES OFFICE
PRESCOTT VALLEY AZ
86314
US

IV. Provider business mailing address

8766 E HWY 69 SSO
PRESCOTT VALLEY AZ
86314
US

V. Phone/Fax

Practice location:
  • Phone: 928-759-4028
  • Fax: 928-759-4030
Mailing address:
  • Phone: 928-759-4028
  • Fax: 928-759-4030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN025333
License Number StateAZ

VIII. Authorized Official

Name: KAY B TURNER
Title or Position: DIRECTOR OF SPECIAL EDUCATION
Credential: EDD
Phone: 928-759-4028