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1073199725 NPI number — KERRI ANNE EVANS LCSW

NPI Number: 1073199725
Health Care Provider/Practitioner: KERRI ANNE EVANS LCSW

Information about “1073199725” NPI (KERRI ANNE EVANS LCSW) exists in 1073199725 in HTML format HTML  |  1073199725 in plain Text format TXT  |  1073199725 in PDF (Portable Document Format) PDF  |  1073199725 in an XML format XML  formats.

NPI Number : 1073199725 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073199725",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EVANS",
    "FirstName": "KERRI",
    "MiddleName": "ANNE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LCSW",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1532 KINGSLEY AVE STE 112",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ORANGE PARK",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32073-4536",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "904-214-3222",
    "MailingAddressFaxNumber": "904-621-9140",
    "FirstLinePracticeLocationAddress": "1532 KINGSLEY AVE STE 112",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ORANGE PARK",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "32073-4536",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "904-214-3222",
    "PracticeLocationAddressFaxNumber": "904-621-9140",
    "EnumerationDate": "03/23/2021",
    "LastUpdateDate": "03/23/2021",
    "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": "1041C0700X",
        "TaxonomyName": "Clinical Social Worker",
        "LicenseNumber": "SW18136",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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