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1770988800 NPI number — KRISTA GAIL ROACH APRN

NPI Number: 1770988800
Health Care Provider/Practitioner: KRISTA GAIL ROACH APRN

Information about “1770988800” NPI (KRISTA GAIL ROACH APRN) exists in 1770988800 in HTML format HTML  |  1770988800 in plain Text format TXT  |  1770988800 in PDF (Portable Document Format) PDF  |  1770988800 in an XML format XML  formats.

NPI Number : 1770988800 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1770988800",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ROACH",
    "FirstName": "KRISTA",
    "MiddleName": "GAIL",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "APRN",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "HESTER",
    "OtherFirstName": "KRISTA",
    "OtherMiddleName": "GAIL",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "422 HEYWOOD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LOUISVILLE",
    "MailingAddressStateName": "KY",
    "MailingAddressPostalCode": "40208-1346",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "502-636-3133",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "422 HEYWOOD AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LOUISVILLE",
    "PracticeLocationAddressStateName": "KY",
    "PracticeLocationAddressPostalCode": "40208-1346",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "502-636-3133",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/31/2014",
    "LastUpdateDate": "07/14/2023",
    "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": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "3009011",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LW0102X",
          "TaxonomyName": "Women's Health Nurse Practitioner",
          "LicenseNumber": "3009011",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "3009011",
          "LicenseNumberStateCode": "KY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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