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1639745425 NPI number — KESHUANA LESHAY GROOMS

NPI Number: 1639745425
Health Care Provider/Practitioner: KESHUANA LESHAY GROOMS

Information about “1639745425” NPI (KESHUANA LESHAY GROOMS) exists in 1639745425 in HTML format HTML  |  1639745425 in plain Text format TXT  |  1639745425 in PDF (Portable Document Format) PDF  |  1639745425 in an XML format XML  formats.

NPI Number : 1639745425 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1639745425",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GROOMS",
    "FirstName": "KESHUANA",
    "MiddleName": "LESHAY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3536 SAINT MARYS RD LOT A61",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "COLUMBUS",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31906-4588",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "229-288-6892",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3536 SAINT MARYS RD LOT A61",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBUS",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31906-4588",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "229-288-6892",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/02/2021",
    "LastUpdateDate": "06/02/2021",
    "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": "251B00000X",
        "TaxonomyName": "Case Management Agency",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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