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1215484076 NPI number — KRISTOPHER PICARELLA ATC

NPI Number: 1215484076
Health Care Provider/Practitioner: KRISTOPHER PICARELLA ATC

Information about “1215484076” NPI (KRISTOPHER PICARELLA ATC) exists in 1215484076 in HTML format HTML  |  1215484076 in plain Text format TXT  |  1215484076 in PDF (Portable Document Format) PDF  |  1215484076 in an XML format XML  formats.

NPI Number : 1215484076 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215484076",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PICARELLA",
    "FirstName": "KRISTOPHER",
    "MiddleName": null,
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PICARELLA",
    "OtherFirstName": "KIP",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": null,
    "OtherCredential": "ATC",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "711 WAILEPO PL",
    "SecondLineMailingAddress": "APT 103",
    "MailingAddressCityName": "KAILUA",
    "MailingAddressStateName": "HI",
    "MailingAddressPostalCode": "96734-2609",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "711 WAILEPO PL",
    "SecondLinePracticeLocationAddress": "APT 103",
    "PracticeLocationAddressCityName": "KAILUA",
    "PracticeLocationAddressStateName": "HI",
    "PracticeLocationAddressPostalCode": "96734-2609",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "903-475-3022",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/08/2016",
    "LastUpdateDate": "09/08/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "AT261",
        "LicenseNumberStateCode": "HI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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