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1619111762 NPI number — KELSEY BLOCH LIVENGOOD O.D.

NPI Number: 1619111762
Health Care Provider/Practitioner: KELSEY BLOCH LIVENGOOD O.D.

Information about “1619111762” NPI (KELSEY BLOCH LIVENGOOD O.D.) exists in 1619111762 in HTML format HTML  |  1619111762 in plain Text format TXT  |  1619111762 in PDF (Portable Document Format) PDF  |  1619111762 in an XML format XML  formats.

NPI Number : 1619111762 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1619111762",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LIVENGOOD",
    "FirstName": "KELSEY",
    "MiddleName": "BLOCH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BLOCH",
    "OtherFirstName": "KELSEY",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "O.D.",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 28",
    "SecondLineMailingAddress": "CABOT FAMILY CARE",
    "MailingAddressCityName": "CABOT",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72023-0028",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "713-306-2422",
    "MailingAddressFaxNumber": "501-843-2599",
    "FirstLinePracticeLocationAddress": "32 S PINE ST",
    "SecondLinePracticeLocationAddress": "SUITE 1",
    "PracticeLocationAddressCityName": "CABOT",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72023-3830",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "713-306-2422",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/20/2009",
    "LastUpdateDate": "01/10/2014",
    "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": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "2889",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "2640",
          "LicenseNumberStateCode": "AR",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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