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1386551794 NPI number — BRECKEN SPENCER BERTIE

NPI Number: 1386551794
Health Care Provider/Practitioner: BRECKEN SPENCER BERTIE

Information about “1386551794” NPI (BRECKEN SPENCER BERTIE) exists in 1386551794 in HTML format HTML  |  1386551794 in plain Text format TXT  |  1386551794 in PDF (Portable Document Format) PDF  |  1386551794 in an XML format XML  formats.

NPI Number : 1386551794 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1386551794",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERTIE",
    "FirstName": "BRECKEN",
    "MiddleName": "SPENCER",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2600 LINKS LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDEPENDENCE",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "67301-1620",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2010 BECKER DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LAWRENCE",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "66047-1620",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "785-864-3591",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/24/2026",
    "LastUpdateDate": "08/24/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "390200000X",
        "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
        "LicenseNumber": "3-120529",
        "LicenseNumberStateCode": "KS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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