1043982135 NPI number — KELSEY ROSE NOBLES M.S. CCC-SLP

NPI Number: 1043982135
Health Care Provider/Practitioner: KELSEY ROSE NOBLES M.S. CCC-SLP

NPI Number : 1043982135 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1043982135",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NOBLES",
    "FirstName": "KELSEY",
    "MiddleName": "ROSE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "M.S. CCC-SLP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BURKE",
    "OtherFirstName": "KELSEY",
    "OtherMiddleName": "ROSE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "M.S. CCC-SLP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "102 EAST AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WAYLAND",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "14572-1106",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "585-397-4079",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "62 PROSPECT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WARSAW",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "14569-1533",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "585-397-4079",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/28/2021",
    "LastUpdateDate": "12/20/2024",
    "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": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": "033394",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "235Z00000X",
          "TaxonomyName": "Speech-Language Pathologist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}