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1710601174 NPI number — MIRANDA CLARE KEPLER

NPI Number: 1710601174
Health Care Provider/Practitioner: MIRANDA CLARE KEPLER

Information about “1710601174” NPI (MIRANDA CLARE KEPLER) exists in 1710601174 in HTML format HTML  |  1710601174 in plain Text format TXT  |  1710601174 in PDF (Portable Document Format) PDF  |  1710601174 in an XML format XML  formats.

NPI Number : 1710601174 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1710601174",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KEPLER",
    "FirstName": "MIRANDA",
    "MiddleName": "CLARE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MICKIEWICZ",
    "OtherFirstName": "MIRANDA",
    "OtherMiddleName": "CLARE",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "58147 COLUMBIA RIVER HWY STE C",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SAINT HELENS",
    "MailingAddressStateName": "OR",
    "MailingAddressPostalCode": "97051-6229",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "510-364-7657",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "58147 COLUMBIA RIVER HWY STE C",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SAINT HELENS",
    "PracticeLocationAddressStateName": "OR",
    "PracticeLocationAddressPostalCode": "97051-6229",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "510-364-7657",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/29/2022",
    "LastUpdateDate": "09/29/2022",
    "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": "174H00000X",
          "TaxonomyName": "Health Educator",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "171M00000X",
          "TaxonomyName": "Case Manager/Care Coordinator",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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