NPI Code Detail JSON Logo

1336576305 NPI number — KELLY MARIE PRALL PA-C

NPI Number: 1336576305
Health Care Provider/Practitioner: KELLY MARIE PRALL PA-C

Information about “1336576305” NPI (KELLY MARIE PRALL PA-C) exists in 1336576305 in HTML format HTML  |  1336576305 in plain Text format TXT  |  1336576305 in PDF (Portable Document Format) PDF  |  1336576305 in an XML format XML  formats.

NPI Number : 1336576305 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336576305",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PRALL",
    "FirstName": "KELLY",
    "MiddleName": "MARIE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PIDGEON",
    "OtherFirstName": "KELLY",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "677 KIDDER STREET",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WILKES-BARRE TWP.",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "18702",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "570-825-2046",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "677 KIDDER STREET",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WILKES-BARRE TWP.",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "18702",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "570-825-2046",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/04/2013",
    "LastUpdateDate": "05/31/2024",
    "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": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "OA003966",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363AM0700X",
          "TaxonomyName": "Medical Physician Assistant",
          "LicenseNumber": "MA056199",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2025 Data Labs Health. All rights reserved.