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1154549970 NPI number — KEVIN LEVESQUE

NPI Number: 1154549970
Health Care Provider/Practitioner: KEVIN LEVESQUE

Information about “1154549970” NPI (KEVIN LEVESQUE) exists in 1154549970 in HTML format HTML  |  1154549970 in plain Text format TXT  |  1154549970 in PDF (Portable Document Format) PDF  |  1154549970 in an XML format XML  formats.

NPI Number : 1154549970 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154549970",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEVESQUE",
    "FirstName": "KEVIN",
    "MiddleName": null,
    "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": "2501 CARRIAGE CROSSING DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MATTHEWS",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28105-8827",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "704-841-1865",
    "MailingAddressFaxNumber": "714-841-1394",
    "FirstLinePracticeLocationAddress": "1830 GALLERIA BLVD.",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLOTTE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28270",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-841-1865",
    "PracticeLocationAddressFaxNumber": "714-841-1394",
    "EnumerationDate": "04/24/2007",
    "LastUpdateDate": "07/31/2014",
    "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": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "PR4851",
          "LicenseNumberStateCode": "ME",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "19322",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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