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1225595911 NPI number — PAETON MOYLE PA-C

NPI Number: 1225595911
Health Care Provider/Practitioner: PAETON MOYLE PA-C

Information about “1225595911” NPI (PAETON MOYLE PA-C) exists in 1225595911 in HTML format HTML  |  1225595911 in plain Text format TXT  |  1225595911 in PDF (Portable Document Format) PDF  |  1225595911 in an XML format XML  formats.

NPI Number : 1225595911 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1225595911",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOYLE",
    "FirstName": "PAETON",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "LARSON",
    "OtherFirstName": "PAETON",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5713 BENDT DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RAPID CITY",
    "MailingAddressStateName": "SD",
    "MailingAddressPostalCode": "57702-9618",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "605-393-7051",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2820 MOUNT RUSHMORE RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RAPID CITY",
    "PracticeLocationAddressStateName": "SD",
    "PracticeLocationAddressPostalCode": "57701-5474",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "605-342-3280",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/28/2019",
    "LastUpdateDate": "12/14/2020",
    "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": "1181",
        "LicenseNumberStateCode": "SD",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY  GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
      }
    }
  }
}
                
            

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