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1023580198 NPI number — LAKESHA WILSON BURNELL NURSE PRACTITIONER

NPI Number: 1023580198
Health Care Provider/Practitioner: LAKESHA WILSON BURNELL NURSE PRACTITIONER

Information about “1023580198” NPI (LAKESHA WILSON BURNELL NURSE PRACTITIONER) exists in 1023580198 in HTML format HTML  |  1023580198 in plain Text format TXT  |  1023580198 in PDF (Portable Document Format) PDF  |  1023580198 in an XML format XML  formats.

NPI Number : 1023580198 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023580198",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURNELL",
    "FirstName": "LAKESHA",
    "MiddleName": "WILSON",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NURSE PRACTITIONER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BURNELL",
    "OtherFirstName": "LAKESHA",
    "OtherMiddleName": "WILSON",
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "NP",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "203 LOUDON HILL DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WARNER ROBINS",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31088-8531",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "478-550-5789",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "655 7TH ST BLDG 700700A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WARNER ROBINS",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31098-2227",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "478-497-1993",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/29/2018",
    "LastUpdateDate": "09/06/2019",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "RN148146",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "RN148146",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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