NPI Code Detail JSON Logo

1063967495 NPI number — CORA E MIKESELL PA-C

NPI Number: 1063967495
Health Care Provider/Practitioner: CORA E MIKESELL PA-C

Information about “1063967495” NPI (CORA E MIKESELL PA-C) exists in 1063967495 in HTML format HTML  |  1063967495 in plain Text format TXT  |  1063967495 in PDF (Portable Document Format) PDF  |  1063967495 in an XML format XML  formats.

NPI Number : 1063967495 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1063967495",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MIKESELL",
    "FirstName": "CORA",
    "MiddleName": "E",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CHAMBERLAIN",
    "OtherFirstName": "CORA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "299 KINGS DAUGHTERS DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FRANKFORT",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40601-6514",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "299 KINGS DAUGHTERS DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FRANKFORT",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40601-6514",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "502-875-5240",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/15/2016",
    "LastUpdateDate": "04/03/2025",
    "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": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "10003111A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA2122",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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