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1174355986 NPI number — JESSICA SUE TABER WHCNP-BC

NPI Number: 1174355986
Health Care Provider/Practitioner: JESSICA SUE TABER WHCNP-BC

Information about “1174355986” NPI (JESSICA SUE TABER WHCNP-BC) exists in 1174355986 in HTML format HTML  |  1174355986 in plain Text format TXT  |  1174355986 in PDF (Portable Document Format) PDF  |  1174355986 in an XML format XML  formats.

NPI Number : 1174355986 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174355986",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TABER",
    "FirstName": "JESSICA",
    "MiddleName": "SUE",
    "NamePrefix": "MISS",
    "NameSuffix": null,
    "Credential": "WHCNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "ELLIOTT",
    "OtherFirstName": "JESSICA",
    "OtherMiddleName": "SUE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 751649",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28275-1649",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "888-472-0043",
    "MailingAddressFaxNumber": "843-724-2454",
    "FirstLinePracticeLocationAddress": "2095 HENRY TECKLENBURG DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLESTON",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29414-5733",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-402-2028",
    "PracticeLocationAddressFaxNumber": "843-402-2023",
    "EnumerationDate": "08/19/2024",
    "LastUpdateDate": "03/17/2026",
    "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": "363LW0102X",
          "TaxonomyName": "Women's Health Nurse Practitioner",
          "LicenseNumber": "36849",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LW0102X",
          "TaxonomyName": "Women's Health Nurse Practitioner",
          "LicenseNumber": "31406",
          "LicenseNumberStateCode": "SC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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