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1801322425 NPI number — STEPHANIE DYKES

NPI Number: 1801322425
Health Care Provider/Practitioner: STEPHANIE DYKES

Information about “1801322425” NPI (STEPHANIE DYKES) exists in 1801322425 in HTML format HTML  |  1801322425 in plain Text format TXT  |  1801322425 in PDF (Portable Document Format) PDF  |  1801322425 in an XML format XML  formats.

NPI Number : 1801322425 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801322425",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DYKES",
    "FirstName": "STEPHANIE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "2367 ANGEL RD SE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PALM BAY",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "32909-6457",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "772-463-0444",
    "MailingAddressFaxNumber": "772-219-1339",
    "FirstLinePracticeLocationAddress": "1887 SE PORT ST LUCIE BLVD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PORT ST LUCIE",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "34952-5530",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "772-463-0444",
    "PracticeLocationAddressFaxNumber": "772-219-1339",
    "EnumerationDate": "05/02/2017",
    "LastUpdateDate": "10/25/2022",
    "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": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": "1733149",
        "LicenseNumberStateCode": "FL",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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