NPI Code Detail JSON Logo

1508380742 NPI number — ABIGAIL BACON ROOT PA-C

NPI Number: 1508380742
Health Care Provider/Practitioner: ABIGAIL BACON ROOT PA-C

Information about “1508380742” NPI (ABIGAIL BACON ROOT PA-C) exists in 1508380742 in HTML format HTML  |  1508380742 in plain Text format TXT  |  1508380742 in PDF (Portable Document Format) PDF  |  1508380742 in an XML format XML  formats.

NPI Number : 1508380742 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1508380742",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROOT",
    "FirstName": "ABIGAIL",
    "MiddleName": "BACON",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BACON",
    "OtherFirstName": "ABIGAIL",
    "OtherMiddleName": "FRITZ",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA-C",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "201 STATE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ERIE",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "16550-0002",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "814-877-6139",
    "MailingAddressFaxNumber": "814-877-6093",
    "FirstLinePracticeLocationAddress": "201 STATE ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ERIE",
    "PracticeLocationAddressStateName": "PA",
    "PracticeLocationAddressPostalCode": "16550-0002",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "814-877-6139",
    "PracticeLocationAddressFaxNumber": "814-877-6093",
    "EnumerationDate": "07/31/2017",
    "LastUpdateDate": "02/05/2020",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "MA059181",
        "LicenseNumberStateCode": "PA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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