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1073448106 NPI number — JACOB MICHAEL PRESTIDGE

NPI Number: 1073448106
Health Care Provider/Practitioner: JACOB MICHAEL PRESTIDGE

Information about “1073448106” NPI (JACOB MICHAEL PRESTIDGE) exists in 1073448106 in HTML format HTML  |  1073448106 in plain Text format TXT  |  1073448106 in PDF (Portable Document Format) PDF  |  1073448106 in an XML format XML  formats.

NPI Number : 1073448106 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1073448106",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PRESTIDGE",
    "FirstName": "JACOB",
    "MiddleName": "MICHAEL",
    "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": "7020 WALMER ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OVERLAND PARK",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "66204-1437",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "816-506-8098",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "9393 W 110TH ST STE 532",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OVERLAND PARK",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "66210-1442",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "816-875-0072",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/18/2026",
    "LastUpdateDate": "06/18/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "106H00000X",
        "TaxonomyName": "Marriage & Family Therapist",
        "LicenseNumber": "LMFT03819T",
        "LicenseNumberStateCode": "KS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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