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1083923262 NPI number — PAULINE DEANNIA FAIRCLOTH NP

NPI Number: 1083923262
Health Care Provider/Practitioner: PAULINE DEANNIA FAIRCLOTH NP

Information about “1083923262” NPI (PAULINE DEANNIA FAIRCLOTH NP) exists in 1083923262 in HTML format HTML  |  1083923262 in plain Text format TXT  |  1083923262 in PDF (Portable Document Format) PDF  |  1083923262 in an XML format XML  formats.

NPI Number : 1083923262 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1083923262",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "FAIRCLOTH",
    "FirstName": "PAULINE",
    "MiddleName": "DEANNIA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 40908",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FAYETTEVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28309-0908",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "910-615-6448",
    "MailingAddressFaxNumber": "910-615-5070",
    "FirstLinePracticeLocationAddress": "2301 ROBESON ST",
    "SecondLinePracticeLocationAddress": "SUITE 203",
    "PracticeLocationAddressCityName": "FAYETTEVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28305-5640",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-615-3220",
    "PracticeLocationAddressFaxNumber": "910-486-2170",
    "EnumerationDate": "10/05/2010",
    "LastUpdateDate": "06/19/2019",
    "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": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "164680",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "LicenseNumber": "164680",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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