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1497563696 NPI number — JESSICA NICOLE TANNER PHARMD

NPI Number: 1497563696
Health Care Provider/Practitioner: JESSICA NICOLE TANNER PHARMD

Information about “1497563696” NPI (JESSICA NICOLE TANNER PHARMD) exists in 1497563696 in HTML format HTML  |  1497563696 in plain Text format TXT  |  1497563696 in PDF (Portable Document Format) PDF  |  1497563696 in an XML format XML  formats.

NPI Number : 1497563696 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1497563696",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TANNER",
    "FirstName": "JESSICA",
    "MiddleName": "NICOLE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARMD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 4007",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MOUNT VERNON",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40456-4007",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "606-308-3859",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "14949 N US HIGHWAY 25 E",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CORBIN",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40701-6285",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "606-280-4212",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/20/2024",
    "LastUpdateDate": "12/20/2024",
    "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": "183500000X",
        "TaxonomyName": "Pharmacist",
        "LicenseNumber": "021662",
        "LicenseNumberStateCode": "KY",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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