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1316393879 NPI number — KENNETH COPPERWHEAT DO

NPI Number: 1316393879
Health Care Provider/Practitioner: KENNETH COPPERWHEAT DO

Information about “1316393879” NPI (KENNETH COPPERWHEAT DO) exists in 1316393879 in HTML format HTML  |  1316393879 in plain Text format TXT  |  1316393879 in PDF (Portable Document Format) PDF  |  1316393879 in an XML format XML  formats.

NPI Number : 1316393879 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1316393879",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COPPERWHEAT",
    "FirstName": "KENNETH",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "DO",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5100 W 110TH ST STE 110",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OVERLAND PARK",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "66211-1215",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "913-345-6960",
    "MailingAddressFaxNumber": "913-345-6966",
    "FirstLinePracticeLocationAddress": "2737 WARM SPRINGS RD STE A",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBUS",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31904-5328",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "706-660-2950",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/13/2016",
    "LastUpdateDate": "09/27/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "05-43987",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "208600000X",
          "TaxonomyName": "Surgery Physician",
          "LicenseNumber": "92781",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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