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1689210791 NPI number — ALEXIS TIERRA VAUGHN CMM

NPI Number: 1689210791
Health Care Provider/Practitioner: ALEXIS TIERRA VAUGHN CMM

Information about “1689210791” NPI (ALEXIS TIERRA VAUGHN CMM) exists in 1689210791 in HTML format HTML  |  1689210791 in plain Text format TXT  |  1689210791 in PDF (Portable Document Format) PDF  |  1689210791 in an XML format XML  formats.

NPI Number : 1689210791 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1689210791",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "VAUGHN",
    "FirstName": "ALEXIS",
    "MiddleName": "TIERRA",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "CMM",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SMALLS",
    "OtherFirstName": "ALEXIS",
    "OtherMiddleName": "TIERRA",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4420 BOSTIC DR APT 306",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "GREENVILLE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "27834-9423",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4420 BOSTIC DR APT 306",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GREENVILLE",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27834-9423",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "229-379-8873",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/24/2019",
    "LastUpdateDate": "12/23/2024",
    "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": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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