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1740684901 NPI number — CHARYSSE JOHNSON PA-C

NPI Number: 1740684901
Health Care Provider/Practitioner: CHARYSSE JOHNSON PA-C

Information about “1740684901” NPI (CHARYSSE JOHNSON PA-C) exists in 1740684901 in HTML format HTML  |  1740684901 in plain Text format TXT  |  1740684901 in PDF (Portable Document Format) PDF  |  1740684901 in an XML format XML  formats.

NPI Number : 1740684901 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1740684901",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "JOHNSON",
    "FirstName": "CHARYSSE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BROWN",
    "OtherFirstName": "CHARYSSE",
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "PA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "18 TOWNLEY ST APT H3",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "HARTFORD",
    "MailingAddressStateName": "CT",
    "MailingAddressPostalCode": "06105-1864",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "917-302-5899",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1030 BOULEVARD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "WEST HARTFORD",
    "PracticeLocationAddressStateName": "CT",
    "PracticeLocationAddressPostalCode": "06119-1801",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "860-986-6440",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/17/2014",
    "LastUpdateDate": "03/31/2016",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "3209",
        "LicenseNumberStateCode": "CT",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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