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1275021768 NPI number — KAITLIN ELAINE NICHOLSON ATC

NPI Number: 1275021768
Health Care Provider/Practitioner: KAITLIN ELAINE NICHOLSON ATC

Information about “1275021768” NPI (KAITLIN ELAINE NICHOLSON ATC) exists in 1275021768 in HTML format HTML  |  1275021768 in plain Text format TXT  |  1275021768 in PDF (Portable Document Format) PDF  |  1275021768 in an XML format XML  formats.

NPI Number : 1275021768 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1275021768",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NICHOLSON",
    "FirstName": "KAITLIN",
    "MiddleName": "ELAINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HUGHES",
    "OtherFirstName": "KAITLIN",
    "OtherMiddleName": "ELAINE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5598 SUNRISE DR APT 208",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT MYERS",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33919-1716",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-651-6262",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5598 SUNRISE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT MYERS",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33919-1716",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "239-274-6749",
    "PracticeLocationAddressFaxNumber": "239-274-6787",
    "EnumerationDate": "04/30/2018",
    "LastUpdateDate": "04/30/2018",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "AL5015",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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