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1548061039 NPI number — KYMBER BLY BS, OTC

NPI Number: 1548061039
Health Care Provider/Practitioner: KYMBER BLY BS, OTC

Information about “1548061039” NPI (KYMBER BLY BS, OTC) exists in 1548061039 in HTML format HTML  |  1548061039 in plain Text format TXT  |  1548061039 in PDF (Portable Document Format) PDF  |  1548061039 in an XML format XML  formats.

NPI Number : 1548061039 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548061039",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLY",
    "FirstName": "KYMBER",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "BS, OTC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FRITZ",
    "OtherFirstName": "KYMBER",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "10310 THE GROVE BLVD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BATON ROUGE",
    "MailingAddressStateName": "LA",
    "MailingAddressPostalCode": "70836-6455",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "225-388-6630",
    "MailingAddressFaxNumber": "225-761-5702",
    "FirstLinePracticeLocationAddress": "10310 THE GROVE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BATON ROUGE",
    "PracticeLocationAddressStateName": "LA",
    "PracticeLocationAddressPostalCode": "70836-6455",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "225-388-6630",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/21/2025",
    "LastUpdateDate": "03/21/2025",
    "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": "246ZX2200X",
        "TaxonomyName": "Orthopedic Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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