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1437659190 NPI number — RILEY ODOM NP-C

NPI Number: 1437659190
Health Care Provider/Practitioner: RILEY ODOM NP-C

Information about “1437659190” NPI (RILEY ODOM NP-C) exists in 1437659190 in HTML format HTML  |  1437659190 in plain Text format TXT  |  1437659190 in PDF (Portable Document Format) PDF  |  1437659190 in an XML format XML  formats.

NPI Number : 1437659190 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1437659190",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ODOM",
    "FirstName": "RILEY",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2318 TAFT ST NE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MINNEAPOLIS",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55418-4132",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "559 CAPITOL BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT PAUL",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55103-2101",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-232-2000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/19/2018",
    "LastUpdateDate": "03/22/2018",
    "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": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LC0200X",
          "TaxonomyName": "Critical Care Medicine Nurse Practitioner",
          "LicenseNumber": "5737",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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