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1164902755 NPI number — AMANDA JESSE

NPI Number: 1164902755
Health Care Provider/Practitioner: AMANDA JESSE

Information about “1164902755” NPI (AMANDA JESSE) exists in 1164902755 in HTML format HTML  |  1164902755 in plain Text format TXT  |  1164902755 in PDF (Portable Document Format) PDF  |  1164902755 in an XML format XML  formats.

NPI Number : 1164902755 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1164902755",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JESSE",
    "FirstName": "AMANDA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ECK",
    "OtherFirstName": "AMANDA",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "510 MAPLEWOOD LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SKIATOOK",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "74070-3813",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "918-480-8711",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "202 W 4TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SKIATOOK",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "74070-1409",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "918-408-8711",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/14/2018",
    "LastUpdateDate": "01/27/2023",
    "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": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "101Y00000X",
          "TaxonomyName": "Counselor",
          "LicenseNumber": "LPCCANDIDATE10273",
          "LicenseNumberStateCode": "OK",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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