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1548833965 NPI number — LARONDA LESHELL MOORE

NPI Number: 1548833965
Health Care Provider/Practitioner: LARONDA LESHELL MOORE

Information about “1548833965” NPI (LARONDA LESHELL MOORE) exists in 1548833965 in HTML format HTML  |  1548833965 in plain Text format TXT  |  1548833965 in PDF (Portable Document Format) PDF  |  1548833965 in an XML format XML  formats.

NPI Number : 1548833965 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1548833965",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MOORE",
    "FirstName": "LARONDA",
    "MiddleName": "LESHELL",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "125 COUNTY ROAD 359",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MERIDIAN",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39301-9676",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "601-604-3705",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "111 W CHURCH ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "QUITMAN",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39355-2134",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-604-3705",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/22/2021",
    "LastUpdateDate": "07/22/2021",
    "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": "376J00000X",
        "TaxonomyName": "Homemaker",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "MS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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