NPI Code Detail JSON Logo

1558090969 NPI number — KRISTIE CLARK, PLLC

NPI Number: 1558090969
Health Care Provider/Practitioner: KRISTIE CLARK, PLLC

Information about “1558090969” NPI (KRISTIE CLARK, PLLC) exists in 1558090969 in HTML format HTML  |  1558090969 in plain Text format TXT  |  1558090969 in PDF (Portable Document Format) PDF  |  1558090969 in an XML format XML  formats.

NPI Number : 1558090969 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1558090969",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "KRISTIE CLARK, PLLC",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "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": "12375 WHISPER RIDGE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FREELAND",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48623-9500",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "989-430-6553",
    "MailingAddressFaxNumber": "989-355-0438",
    "FirstLinePracticeLocationAddress": "5090 STATE ST STE B102",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAGINAW",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48603-3778",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "989-430-6553",
    "PracticeLocationAddressFaxNumber": "989-355-0438",
    "EnumerationDate": "06/09/2022",
    "LastUpdateDate": "06/28/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "CLARK",
    "AuthorizedOfficialFirstName": "KRISTIE",
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": "LICENSED PROFESSIONAL COUNSELOR",
    "AuthorizedOfficialNamePrefix": "MRS.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": "989-430-6553",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "251S00000X",
        "TaxonomyName": "Community/Behavioral Health Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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