1629111406 NPI number — BRIDGETT A ALCORN AU.D., CCC-A

NPI Number: 1629111406
Health Care Provider/Practitioner: BRIDGETT A ALCORN AU.D., CCC-A

NPI Number : 1629111406 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629111406",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ALCORN",
    "FirstName": "BRIDGETT",
    "MiddleName": "A",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "AU.D., CCC-A",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "GIVAN",
    "OtherFirstName": "BRIDGETT",
    "OtherMiddleName": "A",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "AU.D., CCC-A",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1733 TEAKWOOD LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HEBRON",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "41048-7003",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "317-362-5990",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1733 TEAKWOOD LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "HEBRON",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "41048-7003",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "317-362-5990",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/14/2007",
    "LastUpdateDate": "08/05/2013",
    "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": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "A01766",
          "LicenseNumberStateCode": "OH",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "231H00000X",
          "TaxonomyName": "Audiologist",
          "LicenseNumber": "23002409A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}