NPI Code Detail JSON Logo

1730638164 NPI number — MARIE COLLINS CUSTEAD

NPI Number: 1730638164
Health Care Provider/Practitioner: MARIE COLLINS CUSTEAD

Information about “1730638164” NPI (MARIE COLLINS CUSTEAD) exists in 1730638164 in HTML format HTML  |  1730638164 in plain Text format TXT  |  1730638164 in PDF (Portable Document Format) PDF  |  1730638164 in an XML format XML  formats.

NPI Number : 1730638164 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1730638164",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CUSTEAD",
    "FirstName": "MARIE",
    "MiddleName": "COLLINS",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "CUSTEAD",
    "OtherFirstName": "MARIE",
    "OtherMiddleName": "COLLINS",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "RD., LD",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "SFA ATHLETIC FIELDHOUSE 712 HAYTER ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NACOGDOCHES",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75962-0001",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "936-468-3506",
    "MailingAddressFaxNumber": "936-468-4052",
    "FirstLinePracticeLocationAddress": "SFA ATHLETIC FIELDHOUSE 712 HAYTER ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NACOGDOCHES",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75962-0001",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "936-468-3506",
    "PracticeLocationAddressFaxNumber": "936-468-4052",
    "EnumerationDate": "09/27/2016",
    "LastUpdateDate": "09/27/2016",
    "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": "133V00000X",
        "TaxonomyName": "Registered Dietitian",
        "LicenseNumber": "DT84467",
        "LicenseNumberStateCode": "TX",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

Copyright © 2007-2025 Data Labs Health. All rights reserved.