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1447702212 NPI number — LAUREN ELAINE PETRY NP

NPI Number: 1447702212
Health Care Provider/Practitioner: LAUREN ELAINE PETRY NP

Information about “1447702212” NPI (LAUREN ELAINE PETRY NP) exists in 1447702212 in HTML format HTML  |  1447702212 in plain Text format TXT  |  1447702212 in PDF (Portable Document Format) PDF  |  1447702212 in an XML format XML  formats.

NPI Number : 1447702212 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1447702212",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PETRY",
    "FirstName": "LAUREN",
    "MiddleName": "ELAINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 4046",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SPRINGFIELD",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65808-4046",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "417-269-5712",
    "MailingAddressFaxNumber": "417-269-7567",
    "FirstLinePracticeLocationAddress": "1423 N JEFFERSON AVE STE K100",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SPRINGFIELD",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65802-1917",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "417-269-3915",
    "PracticeLocationAddressFaxNumber": "417-269-3913",
    "EnumerationDate": "10/27/2016",
    "LastUpdateDate": "05/14/2019",
    "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": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "2007034599",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "2017008465",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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