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1730592494 NPI number — ALYSSA MARIE BRAXTON M.D.

NPI Number: 1730592494
Health Care Provider/Practitioner: ALYSSA MARIE BRAXTON M.D.

Information about “1730592494” NPI (ALYSSA MARIE BRAXTON M.D.) exists in 1730592494 in HTML format HTML  |  1730592494 in plain Text format TXT  |  1730592494 in PDF (Portable Document Format) PDF  |  1730592494 in an XML format XML  formats.

NPI Number : 1730592494 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730592494",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BRAXTON",
    "FirstName": "ALYSSA",
    "MiddleName": "MARIE",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "KENNEDY",
    "OtherFirstName": "ALYSSA",
    "OtherMiddleName": "MAIRE",
    "OtherNamePrefix": "DR.",
    "OtherNameSuffix": null,
    "OtherCredential": "MD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "PO BOX 751649",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28275-1649",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "888-472-0043",
    "MailingAddressFaxNumber": "843-724-2440",
    "FirstLinePracticeLocationAddress": "2097 HENRY TECKLENBURG DR STE 211W",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHARLESTON",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29414-5739",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "843-958-2555",
    "PracticeLocationAddressFaxNumber": "843-402-1961",
    "EnumerationDate": "06/10/2014",
    "LastUpdateDate": "05/19/2025",
    "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": "2084P0800X",
        "TaxonomyName": "Psychiatry Physician",
        "LicenseNumber": "LL36954",
        "LicenseNumberStateCode": "SC",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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