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1407669203 NPI number — CLAY D MAXSON RN

NPI Number: 1407669203
Health Care Provider/Practitioner: CLAY D MAXSON RN

Information about “1407669203” NPI (CLAY D MAXSON RN) exists in 1407669203 in HTML format HTML  |  1407669203 in plain Text format TXT  |  1407669203 in PDF (Portable Document Format) PDF  |  1407669203 in an XML format XML  formats.

NPI Number : 1407669203 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1407669203",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAXSON",
    "FirstName": "CLAY",
    "MiddleName": "D",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "RN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "216 PROMISE LN APT 303",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LAFAYETTE",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "47905-5052",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "765-490-1147",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1907 W SYCAMORE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "KOKOMO",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "46901-5148",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "765-452-5611",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/28/2025",
    "LastUpdateDate": "01/28/2025",
    "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": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "28245948C",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163WE0003X",
          "TaxonomyName": "Emergency Registered Nurse",
          "LicenseNumber": "28245948A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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