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1376187419 NPI number — FREDERICKA L DEMMONS CASE MANAGER

NPI Number: 1376187419
Health Care Provider/Practitioner: FREDERICKA L DEMMONS CASE MANAGER

Information about “1376187419” NPI (FREDERICKA L DEMMONS CASE MANAGER) exists in 1376187419 in HTML format HTML  |  1376187419 in plain Text format TXT  |  1376187419 in PDF (Portable Document Format) PDF  |  1376187419 in an XML format XML  formats.

NPI Number : 1376187419 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376187419",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEMMONS",
    "FirstName": "FREDERICKA",
    "MiddleName": "L",
    "NamePrefix": "MS.",
    "NameSuffix": null,
    "Credential": "CASE MANAGER",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DEMMONS",
    "OtherFirstName": "FREDERICKA",
    "OtherMiddleName": "L",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PRS",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "3095 KETTERING BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MORAINE",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45439-1983",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "937-603-8612",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3095 KETTERING BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MORAINE",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45439-1983",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "937-293-8300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/01/2019",
    "LastUpdateDate": "05/08/2023",
    "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": "175T00000X",
          "TaxonomyName": "Peer Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "LicenseNumber": "1376187419",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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