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1194095588 NPI number — JESSICA ANN TYLER STEVENS APNP

NPI Number: 1194095588
Health Care Provider/Practitioner: JESSICA ANN TYLER STEVENS APNP

Information about “1194095588” NPI (JESSICA ANN TYLER STEVENS APNP) exists in 1194095588 in HTML format HTML  |  1194095588 in plain Text format TXT  |  1194095588 in PDF (Portable Document Format) PDF  |  1194095588 in an XML format XML  formats.

NPI Number : 1194095588 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1194095588",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "STEVENS",
    "FirstName": "JESSICA",
    "MiddleName": "ANN TYLER",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "TYLER",
    "OtherFirstName": "JESSICA",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "309 S WALKER ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ADAMS",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "53910-9210",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "608-343-5165",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "309 S WALKER ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ADAMS",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "53910-9210",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-343-5165",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/03/2012",
    "LastUpdateDate": "02/04/2021",
    "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": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": "10709-33",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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