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1285190504 NPI number — KEYUANA TIERA RUCKER COTA

NPI Number: 1285190504
Health Care Provider/Practitioner: KEYUANA TIERA RUCKER COTA

Information about “1285190504” NPI (KEYUANA TIERA RUCKER COTA) exists in 1285190504 in HTML format HTML  |  1285190504 in plain Text format TXT  |  1285190504 in PDF (Portable Document Format) PDF  |  1285190504 in an XML format XML  formats.

NPI Number : 1285190504 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285190504",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RUCKER",
    "FirstName": "KEYUANA",
    "MiddleName": "TIERA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "COTA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6990 BOXBOROUGH CV",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38119-8783",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "901-562-6476",
    "MailingAddressFaxNumber": "855-232-8604",
    "FirstLinePracticeLocationAddress": "6990 BOXBOROUGH CV",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38119-8783",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-562-6476",
    "PracticeLocationAddressFaxNumber": "855-232-8604",
    "EnumerationDate": "02/11/2019",
    "LastUpdateDate": "02/12/2019",
    "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": "224Z00000X",
        "TaxonomyName": "Occupational Therapy Assistant",
        "LicenseNumber": "2621",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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