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1346972973 NPI number — SHERITA TINA LAKIRA HERNTON PA

NPI Number: 1346972973
Health Care Provider/Practitioner: SHERITA TINA LAKIRA HERNTON PA

Information about “1346972973” NPI (SHERITA TINA LAKIRA HERNTON PA) exists in 1346972973 in HTML format HTML  |  1346972973 in plain Text format TXT  |  1346972973 in PDF (Portable Document Format) PDF  |  1346972973 in an XML format XML  formats.

NPI Number : 1346972973 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1346972973",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HERNTON",
    "FirstName": "SHERITA",
    "MiddleName": "TINA LAKIRA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2650 RIDGE AVE # 1223",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "EVANSTON",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60201-1700",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "847-982-3362",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2650 RIDGE AVE",
    "SecondLinePracticeLocationAddress": "1223",
    "PracticeLocationAddressCityName": "EVANSTON",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60201-1700",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "847-982-3362",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/30/2022",
    "LastUpdateDate": "11/19/2024",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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