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1679866099 NPI number — JESSICA K WHELAN MD

NPI Number: 1679866099
Health Care Provider/Practitioner: JESSICA K WHELAN MD

Information about “1679866099” NPI (JESSICA K WHELAN MD) exists in 1679866099 in HTML format HTML  |  1679866099 in plain Text format TXT  |  1679866099 in PDF (Portable Document Format) PDF  |  1679866099 in an XML format XML  formats.

NPI Number : 1679866099 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1679866099",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WHELAN",
    "FirstName": "JESSICA",
    "MiddleName": "K",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1106 SCARBOROUGH LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "WOODBURY",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55125-4801",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "239-285-9646",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2945 HAZELWOOD ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MAPLEWOOD",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55109-1241",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "651-232-7800",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "05/18/2011",
    "LastUpdateDate": "01/16/2018",
    "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": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "47356",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "63013",
          "LicenseNumberStateCode": "MN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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