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1265138887 NPI number — QUEENETTA JERNAINE RICHARDSON LMT

NPI Number: 1265138887
Health Care Provider/Practitioner: QUEENETTA JERNAINE RICHARDSON LMT

Information about “1265138887” NPI (QUEENETTA JERNAINE RICHARDSON LMT) exists in 1265138887 in HTML format HTML  |  1265138887 in plain Text format TXT  |  1265138887 in PDF (Portable Document Format) PDF  |  1265138887 in an XML format XML  formats.

NPI Number : 1265138887 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1265138887",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RICHARDSON",
    "FirstName": "QUEENETTA",
    "MiddleName": "JERNAINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LMT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3228 UNIVERSITY AVE STE 105-106",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBUS",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31907-7209",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "706-992-6866",
    "MailingAddressFaxNumber": "706-992-6867",
    "FirstLinePracticeLocationAddress": "3228 UNIVERSITY AVE STE 105-106",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBUS",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31907-7209",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-992-6866",
    "PracticeLocationAddressFaxNumber": "706-992-6867",
    "EnumerationDate": "02/06/2023",
    "LastUpdateDate": "02/06/2023",
    "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": "225700000X",
        "TaxonomyName": "Massage Therapist",
        "LicenseNumber": "MT006964",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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