1851802714 NPI number — JACK ANDREW NATION LAT, ATC, ROT, OBT

NPI Number: 1851802714
Health Care Provider/Practitioner: JACK ANDREW NATION LAT, ATC, ROT, OBT

NPI Number : 1851802714 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1851802714",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "NATION",
    "FirstName": "JACK",
    "MiddleName": "ANDREW",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "LAT, ATC, ROT, OBT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "10806 W 91ST ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "OVERLAND PARK",
    "MailingAddressStateName": "KS",
    "MailingAddressPostalCode": "66214-2035",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "913-687-8585",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "7500 QUIVIRA RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SHAWNEE",
    "PracticeLocationAddressStateName": "KS",
    "PracticeLocationAddressPostalCode": "66216-3502",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "913-687-8585",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/18/2017",
    "LastUpdateDate": "10/18/2017",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "2017034150",
          "LicenseNumberStateCode": "MO",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "2255A2300X",
          "TaxonomyName": "Athletic Trainer",
          "LicenseNumber": "24-01233",
          "LicenseNumberStateCode": "KS",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}