NPI Code Detail JSON Logo

1053116558 NPI number — HEIDI M KELLER LPN

NPI Number: 1053116558
Health Care Provider/Practitioner: HEIDI M KELLER LPN

Information about “1053116558” NPI (HEIDI M KELLER LPN) exists in 1053116558 in HTML format HTML  |  1053116558 in plain Text format TXT  |  1053116558 in PDF (Portable Document Format) PDF  |  1053116558 in an XML format XML  formats.

NPI Number : 1053116558 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053116558",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KELLER",
    "FirstName": "HEIDI",
    "MiddleName": "M",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LPN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KELLER",
    "OtherFirstName": "HEIDI",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LPN",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "1320 WOODMAN DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAYTON",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45432-3497",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "937-223-1781",
    "MailingAddressFaxNumber": "937-424-0279",
    "FirstLinePracticeLocationAddress": "1320 WOODMAN DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTON",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45432-3497",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "937-223-1781",
    "PracticeLocationAddressFaxNumber": "937-424-0279",
    "EnumerationDate": "02/18/2025",
    "LastUpdateDate": "02/18/2025",
    "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": "164W00000X",
        "TaxonomyName": "Licensed Practical Nurse",
        "LicenseNumber": "LPN.170046.MEDS-IV",
        "LicenseNumberStateCode": "OH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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