NPI Code Detail JSON Logo

1669626800 NPI number — VIKKI BURLESON-BRYANT NP

NPI Number: 1669626800
Health Care Provider/Practitioner: VIKKI BURLESON-BRYANT NP

Information about “1669626800” NPI (VIKKI BURLESON-BRYANT NP) exists in 1669626800 in HTML format HTML  |  1669626800 in plain Text format TXT  |  1669626800 in PDF (Portable Document Format) PDF  |  1669626800 in an XML format XML  formats.

NPI Number : 1669626800 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669626800",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BURLESON-BRYANT",
    "FirstName": "VIKKI",
    "MiddleName": null,
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BURLESON",
    "OtherFirstName": "VIKKI",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 4018",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "JOHNSON CITY",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37602-4018",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-282-1480",
    "MailingAddressFaxNumber": "423-928-1353",
    "FirstLinePracticeLocationAddress": "115 WOODLAWN DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JOHNSON CITY",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37604-5978",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-282-1480",
    "PracticeLocationAddressFaxNumber": "423-928-1353",
    "EnumerationDate": "11/14/2008",
    "LastUpdateDate": "03/22/2018",
    "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": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "APN0000013646",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "13646",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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