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1598428856 NPI number — KEVIN PIERCE BAUTEL PMHNP-BC

NPI Number: 1598428856
Health Care Provider/Practitioner: KEVIN PIERCE BAUTEL PMHNP-BC

Information about “1598428856” NPI (KEVIN PIERCE BAUTEL PMHNP-BC) exists in 1598428856 in HTML format HTML  |  1598428856 in plain Text format TXT  |  1598428856 in PDF (Portable Document Format) PDF  |  1598428856 in an XML format XML  formats.

NPI Number : 1598428856 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1598428856",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BAUTEL",
    "FirstName": "KEVIN",
    "MiddleName": "PIERCE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PMHNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "37558 KAREN ANN CT",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEW BALTIMORE",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48047-6704",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "586-873-2413",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "42669 GARFIELD RD # 326",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CLINTON TOWNSHIP",
    "PracticeLocationAddressStateName": "MI",
    "PracticeLocationAddressPostalCode": "48038-1653",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "586-412-5321",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/14/2021",
    "LastUpdateDate": "03/26/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP0808X",
        "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
        "LicenseNumber": "4704277557",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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