NPI Code Detail JSON Logo

1053243402 NPI number — REAGAN LAUREN JACKSO9N

NPI Number: 1053243402
Health Care Provider/Practitioner: REAGAN LAUREN JACKSO9N

Information about “1053243402” NPI (REAGAN LAUREN JACKSO9N) exists in 1053243402 in HTML format HTML  |  1053243402 in plain Text format TXT  |  1053243402 in PDF (Portable Document Format) PDF  |  1053243402 in an XML format XML  formats.

NPI Number : 1053243402 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1053243402",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSO9N",
    "FirstName": "REAGAN",
    "MiddleName": "LAUREN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "9281 NW 57TH ST APT 303",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TAMARAC",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33351-4376",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-570-2182",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9281 NW 57TH ST APT 303",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TAMARAC",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33351-4376",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-570-2182",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/01/2026",
    "LastUpdateDate": "06/01/2026",
    "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": "101YM0800X",
        "TaxonomyName": "Mental Health Counselor",
        "LicenseNumber": "IMH28477",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2026 Data Labs Health. All rights reserved.