NPI Code Detail JSON Logo

1184376055 NPI number — WELL SPACE NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC

NPI Number: 1184376055
Health Care Provider/Practitioner: WELL SPACE NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC

Information about “1184376055” NPI (WELL SPACE NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC) exists in 1184376055 in HTML format HTML  |  1184376055 in plain Text format TXT  |  1184376055 in PDF (Portable Document Format) PDF  |  1184376055 in an XML format XML  formats.

NPI Number : 1184376055 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1184376055",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "WELL SPACE NURSE PRACTITIONER IN PSYCHIATRY AND FAMILY HEALTH PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "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": "266 BROADWAY STE 401",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROOKLYN",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11211-6306",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "347-696-1375",
    "MailingAddressFaxNumber": "914-222-8973",
    "FirstLinePracticeLocationAddress": "266 BROADWAY STE 401",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BROOKLYN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11211-6306",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "347-696-1375",
    "PracticeLocationAddressFaxNumber": "914-222-8973",
    "EnumerationDate": "01/21/2022",
    "LastUpdateDate": "01/29/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "JACKSON",
    "AuthorizedOfficialFirstName": "KIMBERLY",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "OWNER",
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "PMHNP",
    "AuthorizedOfficialTelephoneNumber": "347-696-1375",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "261QM2500X",
        "TaxonomyName": "Medical Specialty Clinic/Center",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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