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1174689319 NPI number — JENNIFER P. KETCHEL DDS

NPI Number: 1174689319
Health Care Provider/Practitioner: JENNIFER P. KETCHEL DDS

Information about “1174689319” NPI (JENNIFER P. KETCHEL DDS) exists in 1174689319 in HTML format HTML  |  1174689319 in plain Text format TXT  |  1174689319 in PDF (Portable Document Format) PDF  |  1174689319 in an XML format XML  formats.

NPI Number : 1174689319 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1174689319",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KETCHEL",
    "FirstName": "JENNIFER",
    "MiddleName": "P.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DDS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PETTIT",
    "OtherFirstName": "JENNIFER",
    "OtherMiddleName": "L",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "DDS",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "7410 S. COOPER STREET",
    "SecondLineMailingAddress": "SUITE 100",
    "MailingAddressCityName": "ARLONGTON",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76001",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "817-465-0044",
    "MailingAddressFaxNumber": "817-465-0055",
    "FirstLinePracticeLocationAddress": "7410 S. COOPER STREET",
    "SecondLinePracticeLocationAddress": "SUITE 100",
    "PracticeLocationAddressCityName": "ARLONGTON",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "76001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "817-465-0044",
    "PracticeLocationAddressFaxNumber": "817-465-0055",
    "EnumerationDate": "12/30/2006",
    "LastUpdateDate": "07/16/2013",
    "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": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "20274",
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "1223P0221X",
          "TaxonomyName": "Pediatric Dentistry",
          "LicenseNumber": "019.026689",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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