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1669956728 NPI number — AMETHYST MORIAH CRAWFORD LAT, ATC

NPI Number: 1669956728
Health Care Provider/Practitioner: AMETHYST MORIAH CRAWFORD LAT, ATC

Information about “1669956728” NPI (AMETHYST MORIAH CRAWFORD LAT, ATC) exists in 1669956728 in HTML format HTML  |  1669956728 in plain Text format TXT  |  1669956728 in PDF (Portable Document Format) PDF  |  1669956728 in an XML format XML  formats.

NPI Number : 1669956728 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669956728",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CRAWFORD",
    "FirstName": "AMETHYST",
    "MiddleName": "MORIAH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LAT, ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2515 BRITTONTOWN RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "AFTON",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37616-3951",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "423-525-7616",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2515 BRITTONTOWN RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AFTON",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37616-3951",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "423-525-1959",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/24/2018",
    "LastUpdateDate": "12/30/2019",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "0000002593",
        "LicenseNumberStateCode": "TN",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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