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1700745700 NPI number — ETHAN DAVID WILKINSON-FELGATE

NPI Number: 1700745700
Health Care Provider/Practitioner: ETHAN DAVID WILKINSON-FELGATE

Information about “1700745700” NPI (ETHAN DAVID WILKINSON-FELGATE) exists in 1700745700 in HTML format HTML  |  1700745700 in plain Text format TXT  |  1700745700 in PDF (Portable Document Format) PDF  |  1700745700 in an XML format XML  formats.

NPI Number : 1700745700 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700745700",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WILKINSON-FELGATE",
    "FirstName": "ETHAN",
    "MiddleName": "DAVID",
    "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": "507 DONALDSON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CANTON",
    "MailingAddressStateName": "MO",
    "MailingAddressPostalCode": "63435-1101",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "573-383-4595",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "507 DONALDSON ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CANTON",
    "PracticeLocationAddressStateName": "MO",
    "PracticeLocationAddressPostalCode": "63435-1101",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "573-383-4595",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/16/2026",
    "LastUpdateDate": "01/16/2026",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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