1891070629 NPI number — CHARMAINE JACKSON KRUPKA CNM, FNP-BC, IBCLC

NPI Number: 1891070629
Health Care Provider/Practitioner: CHARMAINE JACKSON KRUPKA CNM, FNP-BC, IBCLC

NPI Number : 1891070629 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1891070629",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KRUPKA",
    "FirstName": "CHARMAINE",
    "MiddleName": "JACKSON",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "CNM, FNP-BC, IBCLC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JACKSON",
    "OtherFirstName": "CHARMAINE",
    "OtherMiddleName": "MARIE",
    "OtherNamePrefix": "MISS",
    "OtherNameSuffix": null,
    "OtherCredential": "CNM, FNP-BC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1003 MANSFIELD AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "NASHVILLE",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "37206-3515",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "615-394-2680",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "4928 EDMONDSON PIKE STE 205",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "NASHVILLE",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "37211-4791",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "615-222-1400",
    "PracticeLocationAddressFaxNumber": "615-222-1410",
    "EnumerationDate": "10/12/2011",
    "LastUpdateDate": "02/13/2025",
    "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": "367A00000X",
          "TaxonomyName": "Advanced Practice Midwife",
          "LicenseNumber": "16156",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "16156",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}