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1336706316 NPI number — MARY KATHLEEN HESIDENCE FNP-C

NPI Number: 1336706316
Health Care Provider/Practitioner: MARY KATHLEEN HESIDENCE FNP-C

Information about “1336706316” NPI (MARY KATHLEEN HESIDENCE FNP-C) exists in 1336706316 in HTML format HTML  |  1336706316 in plain Text format TXT  |  1336706316 in PDF (Portable Document Format) PDF  |  1336706316 in an XML format XML  formats.

NPI Number : 1336706316 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1336706316",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HESIDENCE",
    "FirstName": "MARY",
    "MiddleName": "KATHLEEN",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "FNP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MATTHEWS",
    "OtherFirstName": "MARY",
    "OtherMiddleName": "KAY",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5830 ASBY WAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CUMMING",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30040-0640",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "412-478-9710",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "81 NORTHSIDE DR",
    "SecondLinePracticeLocationAddress": "#100",
    "PracticeLocationAddressCityName": "DAWSONVILLE",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30040",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "412-478-9710",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/24/2019",
    "LastUpdateDate": "05/24/2019",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "RN249265",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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