1396118469 NPI number — KERRY LEE TRAUGOTT DNP, APRN, FNP-BC

NPI Number: 1396118469
Health Care Provider/Practitioner: KERRY LEE TRAUGOTT DNP, APRN, FNP-BC

NPI Number : 1396118469 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1396118469",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TRAUGOTT",
    "FirstName": "KERRY",
    "MiddleName": "LEE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "DNP, APRN, FNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BOWDEN",
    "OtherFirstName": "KERRY",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "RN",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 6048",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BEND",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97708-6048",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "541-382-4900",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2405 E 17TH AVE",
    "SecondLinePracticeLocationAddress": "SUITE 113",
    "PracticeLocationAddressCityName": "SPOKANE",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "99223",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "509-720-8516",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/11/2015",
    "LastUpdateDate": "05/26/2023",
    "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": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "202011163NP-PP",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "AP60605300",
          "LicenseNumberStateCode": "WA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}