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1861410086 NPI number — KELLY J MAUPIN NP

NPI Number: 1861410086
Health Care Provider/Practitioner: KELLY J MAUPIN NP

Information about “1861410086” NPI (KELLY J MAUPIN NP) exists in 1861410086 in HTML format HTML  |  1861410086 in plain Text format TXT  |  1861410086 in PDF (Portable Document Format) PDF  |  1861410086 in an XML format XML  formats.

NPI Number : 1861410086 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1861410086",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "MAUPIN",
    "FirstName": "KELLY",
    "MiddleName": "J",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "PRITCHARD",
    "OtherFirstName": "KELLY",
    "OtherMiddleName": "J",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "NP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "155 RIVERBEND DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTESVILLE",
    "MailingAddressStateName": "VA",
    "MailingAddressPostalCode": "22911-8607",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "434-295-0184",
    "MailingAddressFaxNumber": "434-295-2463",
    "FirstLinePracticeLocationAddress": "8220 MEADOWBRIDGE RD STE 203",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MECHANICSVILLE",
    "PracticeLocationAddressStateName": "VA",
    "PracticeLocationAddressPostalCode": "23116-2339",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "804-764-2200",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/17/2006",
    "LastUpdateDate": "05/08/2025",
    "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": "0024165803",
        "LicenseNumberStateCode": "VA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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