NPI Code Detail JSON Logo

1538025259 NPI number — JAKE CURTIS BACON SR.

NPI Number: 1538025259
Health Care Provider/Practitioner: JAKE CURTIS BACON SR.

Information about “1538025259” NPI (JAKE CURTIS BACON SR.) exists in 1538025259 in HTML format HTML  |  1538025259 in plain Text format TXT  |  1538025259 in PDF (Portable Document Format) PDF  |  1538025259 in an XML format XML  formats.

NPI Number : 1538025259 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1538025259",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BACON",
    "FirstName": "JAKE",
    "MiddleName": "CURTIS",
    "NamePrefix": null,
    "NameSuffix": "SR.",
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "6720 E 69TH ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "TULSA",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "74133-1731",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "539-322-8409",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6720 E 69TH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TULSA",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "74133-1731",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "539-322-8409",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "12/26/2025",
    "LastUpdateDate": "12/26/2025",
    "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": "175T00000X",
        "TaxonomyName": "Peer Specialist",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "OK",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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