{
"Npi": {
"NPI": "1871921759",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MCINTYRE",
"FirstName": "KIMBERLY",
"MiddleName": "D",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "ACNS-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4205 BELFORT RD STE 4015",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32216-3623",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-450-6063",
"MailingAddressFaxNumber": "904-539-4091",
"FirstLinePracticeLocationAddress": "3737 SOUTHERN BLVD STE 2100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KETTERING",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "45429-1285",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "937-433-5309",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/31/2013",
"LastUpdateDate": "11/19/2024",
"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": "364SA2200X",
"TaxonomyName": "Adult Health Clinical Nurse Specialist",
"LicenseNumber": "APRN11013591",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "364SA2200X",
"TaxonomyName": "Adult Health Clinical Nurse Specialist",
"LicenseNumber": "APRN.CNS.15141",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}