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1639583776 NPI number — ANNA LOUISE RICHARDSON FNP

NPI Number: 1639583776
Health Care Provider/Practitioner: ANNA LOUISE RICHARDSON FNP

Information about “1639583776” NPI (ANNA LOUISE RICHARDSON FNP) exists in 1639583776 in HTML format HTML  |  1639583776 in plain Text format TXT  |  1639583776 in PDF (Portable Document Format) PDF  |  1639583776 in an XML format XML  formats.

NPI Number : 1639583776 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639583776",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "RICHARDSON",
    "FirstName": "ANNA",
    "MiddleName": "LOUISE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "114 TOWNPARK DR NW",
    "SecondLineMailingAddress": "STE 240",
    "MailingAddressCityName": "KENNESAW",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30144-5802",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-485-3723",
    "MailingAddressFaxNumber": "678-803-6944",
    "FirstLinePracticeLocationAddress": "3780 OLD NORCROSS RD",
    "SecondLinePracticeLocationAddress": "SUITE 108",
    "PracticeLocationAddressCityName": "DULUTH",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30096-1740",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "404-855-2244",
    "PracticeLocationAddressFaxNumber": "404-793-6105",
    "EnumerationDate": "06/17/2014",
    "LastUpdateDate": "05/09/2017",
    "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": "RN240818",
        "LicenseNumberStateCode": "GA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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