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1801557053 NPI number — SHELBY KATHERINE BERNARD PA- C (ANTICIPATED)

NPI Number: 1801557053
Health Care Provider/Practitioner: SHELBY KATHERINE BERNARD PA- C (ANTICIPATED)

Information about “1801557053” NPI (SHELBY KATHERINE BERNARD PA- C (ANTICIPATED)) exists in 1801557053 in HTML format HTML  |  1801557053 in plain Text format TXT  |  1801557053 in PDF (Portable Document Format) PDF  |  1801557053 in an XML format XML  formats.

NPI Number : 1801557053 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1801557053",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BERNARD",
    "FirstName": "SHELBY",
    "MiddleName": "KATHERINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA- C (ANTICIPATED)",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1513 HYDE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "LA CROSSE",
    "MailingAddressStateName": "WI",
    "MailingAddressPostalCode": "54601",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1836 SOUTH AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "LA CROSSE",
    "PracticeLocationAddressStateName": "WI",
    "PracticeLocationAddressPostalCode": "54601-5429",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "608-782-7300",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/09/2022",
    "LastUpdateDate": "05/04/2022",
    "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": "363AS0400X",
        "TaxonomyName": "Surgical Physician Assistant",
        "LicenseNumber": "5776",
        "LicenseNumberStateCode": "WI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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