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1740055821 NPI number — KESHA PHILLIPS MSN, APRN, PMHNP

NPI Number: 1740055821
Health Care Provider/Practitioner: KESHA PHILLIPS MSN, APRN, PMHNP

Information about “1740055821” NPI (KESHA PHILLIPS MSN, APRN, PMHNP) exists in 1740055821 in HTML format HTML  |  1740055821 in plain Text format TXT  |  1740055821 in PDF (Portable Document Format) PDF  |  1740055821 in an XML format XML  formats.

NPI Number : 1740055821 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740055821",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PHILLIPS",
    "FirstName": "KESHA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MSN, APRN, PMHNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "5 VIOLET RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LEVITTOWN",
    "MailingAddressStateName": "PA",
    "MailingAddressPostalCode": "19057-4208",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "609-273-9036",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "100 K JOHNSON BLVD STE 201",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "BORDENTOWN",
    "PracticeLocationAddressStateName": "NJ",
    "PracticeLocationAddressPostalCode": "08505-2275",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "609-273-9036",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/20/2023",
    "LastUpdateDate": "02/20/2024",
    "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": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "26NJ14945100",
          "LicenseNumberStateCode": "NJ",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "SP028691",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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