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1467024745 NPI number — CHARMAISE LYNETTE MIMS LVN

NPI Number: 1467024745
Health Care Provider/Practitioner: CHARMAISE LYNETTE MIMS LVN

Information about “1467024745” NPI (CHARMAISE LYNETTE MIMS LVN) exists in 1467024745 in HTML format HTML  |  1467024745 in plain Text format TXT  |  1467024745 in PDF (Portable Document Format) PDF  |  1467024745 in an XML format XML  formats.

NPI Number : 1467024745 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1467024745",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MIMS",
    "FirstName": "CHARMAISE",
    "MiddleName": "LYNETTE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LVN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6380 BIGNER RD",
    "SecondLineMailingAddress": "6380BIGNER RD",
    "MailingAddressCityName": "BEAUMONT",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77703",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "409-351-0396",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6380 BIGNER ROAD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BEAUMONT",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77708",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "409-351-0396",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/15/2021",
    "LastUpdateDate": "07/15/2021",
    "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": "164W00000X",
        "TaxonomyName": "Licensed Practical Nurse",
        "LicenseNumber": "227680",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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