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1023769965 NPI number — ASHLEY BENITEZ

NPI Number: 1023769965
Health Care Provider/Practitioner: ASHLEY BENITEZ

Information about “1023769965” NPI (ASHLEY BENITEZ) exists in 1023769965 in HTML format HTML  |  1023769965 in plain Text format TXT  |  1023769965 in PDF (Portable Document Format) PDF  |  1023769965 in an XML format XML  formats.

NPI Number : 1023769965 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1023769965",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BENITEZ",
    "FirstName": "ASHLEY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ROBERTS",
    "OtherFirstName": "ASHLEY",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "249 VALLEY DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BREMEN",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30110-5435",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "256-525-0834",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1009 ALABAMA AVE S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BREMEN",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30110-2501",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-821-6400",
    "PracticeLocationAddressFaxNumber": "678-821-6401",
    "EnumerationDate": "01/12/2022",
    "LastUpdateDate": "03/20/2025",
    "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": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "1-175802",
          "LicenseNumberStateCode": "AL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "RN278135",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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