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1659307379 NPI number — JOSHUA CHARLES YONKER MS, LAT, ATC

NPI Number: 1659307379
Health Care Provider/Practitioner: JOSHUA CHARLES YONKER MS, LAT, ATC

Information about “1659307379” NPI (JOSHUA CHARLES YONKER MS, LAT, ATC) exists in 1659307379 in HTML format HTML  |  1659307379 in plain Text format TXT  |  1659307379 in PDF (Portable Document Format) PDF  |  1659307379 in an XML format XML  formats.

NPI Number : 1659307379 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659307379",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "YONKER",
    "FirstName": "JOSHUA",
    "MiddleName": "CHARLES",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "MS, LAT, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "211 RED BIRD LANE",
    "SecondLineMailingAddress": "CAMPUS BOX 10611",
    "MailingAddressCityName": "BEAUMONT",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "77710",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "409-880-2359",
    "MailingAddressFaxNumber": "409-880-2366",
    "FirstLinePracticeLocationAddress": "4400 S. MLK JR PKWY",
    "SecondLinePracticeLocationAddress": "LAMAR UNIV. DAUPHIN ATHLETIC COMPLEX",
    "PracticeLocationAddressCityName": "BEAUMONT",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "77705",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "409-880-2359",
    "PracticeLocationAddressFaxNumber": "409-880-2366",
    "EnumerationDate": "06/24/2006",
    "LastUpdateDate": "07/21/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "07/17/2007",
    "NPIReactivationDate": "06/07/2017",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "AT3457",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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