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1154988483 NPI number — KELLY JEAN O'BRIEN CDA, RDH, MED

NPI Number: 1154988483
Health Care Provider/Practitioner: KELLY JEAN O'BRIEN CDA, RDH, MED

Information about “1154988483” NPI (KELLY JEAN O'BRIEN CDA, RDH, MED) exists in 1154988483 in HTML format HTML  |  1154988483 in plain Text format TXT  |  1154988483 in PDF (Portable Document Format) PDF  |  1154988483 in an XML format XML  formats.

NPI Number : 1154988483 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1154988483",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "O'BRIEN",
    "FirstName": "KELLY",
    "MiddleName": "JEAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CDA, RDH, MED",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DODGE",
    "OtherFirstName": "KELLY",
    "OtherMiddleName": "JEAN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "NHTI-CONCORD'S COMMUNITY COLLEGE",
    "SecondLineMailingAddress": "31 COLLEGE DRIVE",
    "MailingAddressCityName": "CONCORD",
    "MailingAddressStateName": "NH",
    "MailingAddressPostalCode": "03301",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "603-271-6484",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "NHTI-CONCORD'S COMMUNITY COLLEGE",
    "SecondLinePracticeLocationAddress": "31 COLLEGE DRIVE",
    "PracticeLocationAddressCityName": "CONCORD",
    "PracticeLocationAddressStateName": "NH",
    "PracticeLocationAddressPostalCode": "03301",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "603-271-6484",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/22/2019",
    "LastUpdateDate": "05/22/2019",
    "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": "124Q00000X",
        "TaxonomyName": "Dental Hygienist",
        "LicenseNumber": "02411",
        "LicenseNumberStateCode": "NH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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