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1699014746 NPI number — DEWANNA HENDERSON PA-C, BA

NPI Number: 1699014746
Health Care Provider/Practitioner: DEWANNA HENDERSON PA-C, BA

Information about “1699014746” NPI (DEWANNA HENDERSON PA-C, BA) exists in 1699014746 in HTML format HTML  |  1699014746 in plain Text format TXT  |  1699014746 in PDF (Portable Document Format) PDF  |  1699014746 in an XML format XML  formats.

NPI Number : 1699014746 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1699014746",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "HENDERSON",
    "FirstName": "DEWANNA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C, BA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5729 LEBANON RD",
    "SecondLineMailingAddress": "STE 144-425",
    "MailingAddressCityName": "FRISCO",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75034-7260",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "305 S BENEDICT AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "OAK RIDGE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37830-7310",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "865-685-0022",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/10/2013",
    "LastUpdateDate": "01/17/2017",
    "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": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "2315",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106E00000X",
          "TaxonomyName": "Assistant Behavior Analyst",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "TX",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "7034",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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