1457859480 NPI number — KIMBERLY ANN MCNAMARA MS, LAT, ATC, NREMT

NPI Number: 1457859480
Health Care Provider/Practitioner: KIMBERLY ANN MCNAMARA MS, LAT, ATC, NREMT

NPI Number : 1457859480 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1457859480",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MCNAMARA",
    "FirstName": "KIMBERLY",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MS, LAT, ATC, NREMT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BUCKHOLTS",
    "OtherFirstName": "KIMBERLY",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MS, LAT, ATC, NREMT",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "100 COCONUT GROVE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NICHOLASVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40356-2316",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "802-735-7689",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "400 W WALNUT ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DANVILLE",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40422-8707",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "802-735-7689",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/24/2018",
    "LastUpdateDate": "07/19/2023",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}