NPI Code Detail JSON Logo

1164003570 NPI number — JOHNATHAN DONALD DEBETTA

NPI Number: 1164003570
Health Care Provider/Practitioner: JOHNATHAN DONALD DEBETTA

Information about “1164003570” NPI (JOHNATHAN DONALD DEBETTA) exists in 1164003570 in HTML format HTML  |  1164003570 in plain Text format TXT  |  1164003570 in PDF (Portable Document Format) PDF  |  1164003570 in an XML format XML  formats.

NPI Number : 1164003570 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164003570",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEBETTA",
    "FirstName": "JOHNATHAN",
    "MiddleName": "DONALD",
    "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": "10118 KNOTTY PINE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RALEIGH",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27617-8218",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "631-678-8049",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4350 US 421 S",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LILLINGTON",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27546-6760",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "910-893-1210",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/16/2021",
    "LastUpdateDate": "12/07/2021",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "0010-11534",
        "LicenseNumberStateCode": "NC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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