NPI Code Detail JSON Logo

1316141377 NPI number — NICOLE ANTOINETTE WARE SPENCER PSY D

NPI Number: 1316141377
Health Care Provider/Practitioner: NICOLE ANTOINETTE WARE SPENCER PSY D

Information about “1316141377” NPI (NICOLE ANTOINETTE WARE SPENCER PSY D) exists in 1316141377 in HTML format HTML  |  1316141377 in plain Text format TXT  |  1316141377 in PDF (Portable Document Format) PDF  |  1316141377 in an XML format XML  formats.

NPI Number : 1316141377 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316141377",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WARE SPENCER",
    "FirstName": "NICOLE",
    "MiddleName": "ANTOINETTE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PSY D",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 1461",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TUCKER",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30085-1461",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "470-810-7811",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4325 1ST AVE # 1461",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TUCKER",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30084-4498",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-404-1077",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/13/2007",
    "LastUpdateDate": "01/12/2023",
    "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": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "6301013431",
          "LicenseNumberStateCode": "MI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "PSY004171",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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