1639203250 NPI number — LYN BROOKS-TAYLOR MAT, RD, LDN, CHFS

NPI Number: 1639203250
Health Care Provider/Practitioner: LYN BROOKS-TAYLOR MAT, RD, LDN, CHFS

NPI Number : 1639203250 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639203250",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BROOKS-TAYLOR",
    "FirstName": "LYN",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "MAT, RD, LDN, CHFS",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BROOKS",
    "OtherFirstName": "LYN",
    "OtherMiddleName": null,
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "MAT, RD, LDN, CHFS",
    "OtherLastNameTypeCode": "2",
    "FirstLineMailingAddress": "2491 BROOKS RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BELDEN",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "38826-9548",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "662-397-6053",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2491 BROOKS RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BELDEN",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "38826-9548",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "662-397-6053",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/15/2007",
    "LastUpdateDate": "01/07/2011",
    "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": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": "LDN1336",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "133V00000X",
          "TaxonomyName": "Registered Dietitian",
          "LicenseNumber": "D0455",
          "LicenseNumberStateCode": "MS",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}