NPI Code Detail JSON Logo

1215584792 NPI number — EMILY ELIZABETH PROUD

NPI Number: 1215584792
Health Care Provider/Practitioner: EMILY ELIZABETH PROUD

Information about “1215584792” NPI (EMILY ELIZABETH PROUD) exists in 1215584792 in HTML format HTML  |  1215584792 in plain Text format TXT  |  1215584792 in PDF (Portable Document Format) PDF  |  1215584792 in an XML format XML  formats.

NPI Number : 1215584792 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215584792",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PROUD",
    "FirstName": "EMILY",
    "MiddleName": "ELIZABETH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "O'BRIEN",
    "OtherFirstName": "EMILY",
    "OtherMiddleName": "ELIZABETH",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "64 MEDICAL CENTER DR # 9238",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MORGANTOWN",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "26505-3409",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "412-779-1748",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1 MEDICAL CENTER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MORGANTOWN",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "26506-1200",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-296-5169",
    "PracticeLocationAddressFaxNumber": "304-293-1106",
    "EnumerationDate": "08/20/2019",
    "LastUpdateDate": "01/09/2024",
    "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": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "2353",
          "LicenseNumberStateCode": "WV",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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