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1285854828 NPI number — JACQUELINE SUE PERDUE-DORATHY LPN

NPI Number: 1285854828
Health Care Provider/Practitioner: JACQUELINE SUE PERDUE-DORATHY LPN

Information about “1285854828” NPI (JACQUELINE SUE PERDUE-DORATHY LPN) exists in 1285854828 in HTML format HTML  |  1285854828 in plain Text format TXT  |  1285854828 in PDF (Portable Document Format) PDF  |  1285854828 in an XML format XML  formats.

NPI Number : 1285854828 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1285854828",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PERDUE-DORATHY",
    "FirstName": "JACQUELINE",
    "MiddleName": "SUE",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "LPN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PERDUE",
    "OtherFirstName": "JACQUELINE",
    "OtherMiddleName": "SUE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "LPN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "19445 COUNTRYSIDE CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WESTON",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "64098-9127",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "913-684-6170",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "550 POPE AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FORT LEAVENWORTH",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "66027-2332",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "913-681-6170",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/26/2007",
    "LastUpdateDate": "07/08/2007",
    "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": "164W00000X",
        "TaxonomyName": "Licensed Practical Nurse",
        "LicenseNumber": "23-27018-081",
        "LicenseNumberStateCode": "KS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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