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1336276096 NPI number — KELLY A. PATEL NP

NPI Number: 1336276096
Health Care Provider/Practitioner: KELLY A. PATEL NP

Information about “1336276096” NPI (KELLY A. PATEL NP) exists in 1336276096 in HTML format HTML  |  1336276096 in plain Text format TXT  |  1336276096 in PDF (Portable Document Format) PDF  |  1336276096 in an XML format XML  formats.

NPI Number : 1336276096 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336276096",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PATEL",
    "FirstName": "KELLY",
    "MiddleName": "A.",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10777 SUNSET OFFICE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT LOUIS",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63127-1019",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "314-822-5900",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1035 BELLEVUE AVE",
    "SecondLinePracticeLocationAddress": "SUITE 305",
    "PracticeLocationAddressCityName": "SAINT LOUIS",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63117-1854",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "314-925-4700",
    "PracticeLocationAddressFaxNumber": "314-925-4716",
    "EnumerationDate": "02/28/2007",
    "LastUpdateDate": "08/15/2012",
    "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": "363L00000X",
        "TaxonomyName": "Nurse Practitioner",
        "LicenseNumber": "2004007219",
        "LicenseNumberStateCode": "MO",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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