NPI Code Detail JSON Logo

1356962211 NPI number — TRACEY LY PA-C

NPI Number: 1356962211
Health Care Provider/Practitioner: TRACEY LY PA-C

Information about “1356962211” NPI (TRACEY LY PA-C) exists in 1356962211 in HTML format HTML  |  1356962211 in plain Text format TXT  |  1356962211 in PDF (Portable Document Format) PDF  |  1356962211 in an XML format XML  formats.

NPI Number : 1356962211 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1356962211",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LY",
    "FirstName": "TRACEY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6275 E VIRGINIA BEACH BLVD STE 300",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NORFOLK",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "23502-2851",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "757-466-0089",
    "MailingAddressFaxNumber": "757-466-8017",
    "FirstLinePracticeLocationAddress": "600 GRESHAM DR STE 700",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NORFOLK",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23507-1904",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "757-388-1700",
    "PracticeLocationAddressFaxNumber": "423-826-1290",
    "EnumerationDate": "05/01/2020",
    "LastUpdateDate": "11/18/2025",
    "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": "58446",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "0110009247",
          "LicenseNumberStateCode": "VA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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