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1104663657 NPI number — MISS KENEDY MCCADE SISSON

NPI Number: 1104663657
Health Care Provider/Practitioner: MISS KENEDY MCCADE SISSON

Information about “1104663657” NPI (MISS KENEDY MCCADE SISSON) exists in 1104663657 in HTML format HTML  |  1104663657 in plain Text format TXT  |  1104663657 in PDF (Portable Document Format) PDF  |  1104663657 in an XML format XML  formats.

NPI Number : 1104663657 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1104663657",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "SISSON",
    "FirstName": "KENEDY",
    "MiddleName": "MCCADE",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1124 NEW HIGHWAY 52 E",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WESTMORELAND",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37186-5032",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "615-644-2000",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1124 NEW HIGHWAY 52 E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WESTMORELAND",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37186-5032",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "615-644-2000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/11/2024",
    "LastUpdateDate": "11/24/2025",
    "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": "6740",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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