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1093296659 NPI number — KASSANDRA DAWN BRADBERRY

NPI Number: 1093296659
Health Care Provider/Practitioner: KASSANDRA DAWN BRADBERRY

Information about “1093296659” NPI (KASSANDRA DAWN BRADBERRY) exists in 1093296659 in HTML format HTML  |  1093296659 in plain Text format TXT  |  1093296659 in PDF (Portable Document Format) PDF  |  1093296659 in an XML format XML  formats.

NPI Number : 1093296659 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1093296659",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRADBERRY",
    "FirstName": "KASSANDRA",
    "MiddleName": "DAWN",
    "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": "507 MLK BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LUBBOCK",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "79403-5213",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "806-392-9107",
    "MailingAddressFaxNumber": "806-744-0611",
    "FirstLinePracticeLocationAddress": "7208 PRIMROSE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LUBBOCK",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "79424-7723",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "210-386-1776",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/22/2018",
    "LastUpdateDate": "08/22/2018",
    "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": "225200000X",
        "TaxonomyName": "Physical Therapy Assistant",
        "LicenseNumber": "2091085",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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