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1497253512 NPI number — MR. JIMMIE LEE HEAGS JR.

NPI Number: 1497253512
Health Care Provider/Practitioner: MR. JIMMIE LEE HEAGS JR.

Information about “1497253512” NPI (MR. JIMMIE LEE HEAGS JR.) exists in 1497253512 in HTML format HTML  |  1497253512 in plain Text format TXT  |  1497253512 in PDF (Portable Document Format) PDF  |  1497253512 in an XML format XML  formats.

NPI Number : 1497253512 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497253512",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HEAGS",
    "FirstName": "JIMMIE",
    "MiddleName": "LEE",
    "NamePrefix": "MR.",
    "NameSuffix": "JR.",
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HEAGS",
    "OtherFirstName": "JIMMIE",
    "OtherMiddleName": "LEE",
    "OtherNamePrefix": "MR.",
    "OtherNameSuffix": "JR.",
    "OtherCredential": "LPCC",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "5901 BROOKLYN BLVD STE 205",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BROOKLYN CENTER",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55429-2533",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "612-440-0914",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5901 BROOKLYN BLVD STE 205",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BROOKLYN CENTER",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55429-2533",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "612-440-0914",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/23/2018",
    "LastUpdateDate": "01/23/2018",
    "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": "101YP2500X",
        "TaxonomyName": "Professional Counselor",
        "LicenseNumber": "858",
        "LicenseNumberStateCode": "MN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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