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1639389703 NPI number — AMANDA LUCAS PA

NPI Number: 1639389703
Health Care Provider/Practitioner: AMANDA LUCAS PA

Information about “1639389703” NPI (AMANDA LUCAS PA) exists in 1639389703 in HTML format HTML  |  1639389703 in plain Text format TXT  |  1639389703 in PDF (Portable Document Format) PDF  |  1639389703 in an XML format XML  formats.

NPI Number : 1639389703 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639389703",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LUCAS",
    "FirstName": "AMANDA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1200 E BROADWAY",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBIA",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "65201-4978",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1200 E BROADWAY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "65201-4978",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-441-5107",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/23/2007",
    "LastUpdateDate": "09/17/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "07/28/2020",
    "NPIReactivationDate": "09/04/2024",
    "GenderCode": "U",
    "Gender": null,
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "225200000X",
          "TaxonomyName": "Physical Therapy Assistant",
          "LicenseNumber": "2006039114",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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