1164697355 NPI number — JOSEPH HENRY KANCLERZ MSN, NP-C, RNFA

NPI Number: 1164697355
Health Care Provider/Practitioner: JOSEPH HENRY KANCLERZ MSN, NP-C, RNFA

NPI Number : 1164697355 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164697355",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KANCLERZ",
    "FirstName": "JOSEPH",
    "MiddleName": "HENRY",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "MSN, NP-C, RNFA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KANCLERZ",
    "OtherFirstName": "JOEY",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MSN, NP-C, RNFA",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "PO BOX 7042",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHESTNUT MOUNTAIN",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30502-0042",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "678-591-8344",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5742 ALLEE WAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BRASELTON",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30517-6268",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-591-8344",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/28/2008",
    "LastUpdateDate": "10/13/2016",
    "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": "163WR0006X",
          "TaxonomyName": "Registered Nurse First Assistant",
          "LicenseNumber": "RN177592",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "RN177592",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}