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1255731501 NPI number — KEISHA ANTOINETTE MAHONEY FNP

NPI Number: 1255731501
Health Care Provider/Practitioner: KEISHA ANTOINETTE MAHONEY FNP

Information about “1255731501” NPI (KEISHA ANTOINETTE MAHONEY FNP) exists in 1255731501 in HTML format HTML  |  1255731501 in plain Text format TXT  |  1255731501 in PDF (Portable Document Format) PDF  |  1255731501 in an XML format XML  formats.

NPI Number : 1255731501 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1255731501",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAHONEY",
    "FirstName": "KEISHA",
    "MiddleName": "ANTOINETTE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HINES",
    "OtherFirstName": "KEISHA",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MRS.",
    "OtherNameSuffix": null,
    "OtherCredential": "N.P",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "20 STEVEN PL",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SMITHTOWN",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "11787-5423",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "516-754-0073",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "20 STEVEN PL",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SMITHTOWN",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "11787-5423",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "516-754-0073",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/23/2014",
    "LastUpdateDate": "08/23/2014",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "33339112",
        "LicenseNumberStateCode": "NY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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