NPI Code Detail JSON Logo

1578504569 NPI number — JACQUELINE A JACKSON CFNP

NPI Number: 1578504569
Health Care Provider/Practitioner: JACQUELINE A JACKSON CFNP

Information about “1578504569” NPI (JACQUELINE A JACKSON CFNP) exists in 1578504569 in HTML format HTML  |  1578504569 in plain Text format TXT  |  1578504569 in PDF (Portable Document Format) PDF  |  1578504569 in an XML format XML  formats.

NPI Number : 1578504569 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1578504569",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JACKSON",
    "FirstName": "JACQUELINE",
    "MiddleName": "A",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CFNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "FAUCETTE",
    "OtherFirstName": "JACQUELINE",
    "OtherMiddleName": "A",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "CFNP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "5170 US RT 60 EAST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HUNTINGTON",
    "MailingAddressStateName": "WV",
    "MailingAddressPostalCode": "25705",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "304-697-6000",
    "MailingAddressFaxNumber": "304-399-2280",
    "FirstLinePracticeLocationAddress": "5170 US RT 60 EAST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HUNTINGTON",
    "PracticeLocationAddressStateName": "WV",
    "PracticeLocationAddressPostalCode": "25705",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "304-697-6000",
    "PracticeLocationAddressFaxNumber": "304-399-2280",
    "EnumerationDate": "06/09/2006",
    "LastUpdateDate": "10/25/2021",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "34192",
        "LicenseNumberStateCode": "WV",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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