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1578113353 NPI number — JESSICA ANN HERBST

NPI Number: 1578113353
Health Care Provider/Practitioner: JESSICA ANN HERBST

Information about “1578113353” NPI (JESSICA ANN HERBST) exists in 1578113353 in HTML format HTML  |  1578113353 in plain Text format TXT  |  1578113353 in PDF (Portable Document Format) PDF  |  1578113353 in an XML format XML  formats.

NPI Number : 1578113353 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578113353",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HERBST",
    "FirstName": "JESSICA",
    "MiddleName": "ANN",
    "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": "810 DUNAWAY ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MIAMISBURG",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45342-3833",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "937-336-7686",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1112 GALLIA ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORTSMOUTH",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45662-4161",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-674-0981",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/13/2019",
    "LastUpdateDate": "10/16/2023",
    "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": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "00977",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "287507",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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