1659810935 NPI number — STEPHANIE GALE DEVERS CPNP-PC, NNP-BC

NPI Number: 1659810935
Health Care Provider/Practitioner: STEPHANIE GALE DEVERS CPNP-PC, NNP-BC

NPI Number : 1659810935 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1659810935",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DEVERS",
    "FirstName": "STEPHANIE",
    "MiddleName": "GALE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "CPNP-PC, NNP-BC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "DAVIS",
    "OtherFirstName": "STEPHANIE",
    "OtherMiddleName": "GALE",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "52 JOHNNY WORTHAM RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NEWNAN",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "30263-4823",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "678-859-8441",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "52 JOHNNY WORTHAM RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NEWNAN",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "30263-4823",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "678-859-8441",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/19/2017",
    "LastUpdateDate": "06/15/2020",
    "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": "363LP0200X",
          "TaxonomyName": "Pediatric Nurse Practitioner",
          "LicenseNumber": "RN160287",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LN0000X",
          "TaxonomyName": "Neonatal Nurse Practitioner",
          "LicenseNumber": "RN160287",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}