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1629798822 NPI number — KYRA LYN PINEDA GOODELL APRN,CNP

NPI Number: 1629798822
Health Care Provider/Practitioner: KYRA LYN PINEDA GOODELL APRN,CNP

Information about “1629798822” NPI (KYRA LYN PINEDA GOODELL APRN,CNP) exists in 1629798822 in HTML format HTML  |  1629798822 in plain Text format TXT  |  1629798822 in PDF (Portable Document Format) PDF  |  1629798822 in an XML format XML  formats.

NPI Number : 1629798822 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629798822",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOODELL",
    "FirstName": "KYRA LYN",
    "MiddleName": "PINEDA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "APRN,CNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "AUSTRIA",
    "OtherFirstName": "KYRA LYN",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "APRN,CNP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4922 N RONALD RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEORIA",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "61614-4520",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "435 MAXINE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MORTON",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "61550-2498",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "309-263-2424",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/30/2022",
    "LastUpdateDate": "06/14/2023",
    "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": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "041444483",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "209025830",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LP2300X",
          "TaxonomyName": "Primary Care Nurse Practitioner",
          "LicenseNumber": "209.0258230",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "041444483",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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