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1679176051 NPI number — BRANDON LYNN KENTOPP

NPI Number: 1679176051
Health Care Provider/Practitioner: BRANDON LYNN KENTOPP

Information about “1679176051” NPI (BRANDON LYNN KENTOPP) exists in 1679176051 in HTML format HTML  |  1679176051 in plain Text format TXT  |  1679176051 in PDF (Portable Document Format) PDF  |  1679176051 in an XML format XML  formats.

NPI Number : 1679176051 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679176051",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KENTOPP",
    "FirstName": "BRANDON",
    "MiddleName": "LYNN",
    "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": "6941 OAK ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ARVADA",
    "MailingAddressStateName": "CO",
    "MailingAddressPostalCode": "80004-1455",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "316-253-3290",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "777 BANNOCK ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DENVER",
    "PracticeLocationAddressStateName": "CO",
    "PracticeLocationAddressPostalCode": "80204-4597",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "316-253-3290",
    "PracticeLocationAddressFaxNumber": "303-602-2719",
    "EnumerationDate": "11/18/2020",
    "LastUpdateDate": "04/27/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207RC0200X",
          "TaxonomyName": "Critical Care Medicine (Internal Medicine) Physician",
          "LicenseNumber": "209.022117",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LC0200X",
          "TaxonomyName": "Critical Care Medicine Nurse Practitioner",
          "LicenseNumber": "APN.0997291-NP",
          "LicenseNumberStateCode": "CO",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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