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1114473873 NPI number — CHERRY LACRETA BOWEN ATC, LAT

NPI Number: 1114473873
Health Care Provider/Practitioner: CHERRY LACRETA BOWEN ATC, LAT

Information about “1114473873” NPI (CHERRY LACRETA BOWEN ATC, LAT) exists in 1114473873 in HTML format HTML  |  1114473873 in plain Text format TXT  |  1114473873 in PDF (Portable Document Format) PDF  |  1114473873 in an XML format XML  formats.

NPI Number : 1114473873 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114473873",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BOWEN",
    "FirstName": "CHERRY",
    "MiddleName": "LACRETA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC, LAT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "709 OKLAHOMA BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ALVA",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "73717-2749",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "361-227-7355",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "709 E OKLAHOMA BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ALVA",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "73717-7371",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "361-227-7355",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/31/2016",
    "LastUpdateDate": "03/20/2018",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "743",
        "LicenseNumberStateCode": "OK",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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