NPI Code Detail JSON Logo

1902234917 NPI number — KELLY MARIA DORMAN PMHNP

NPI Number: 1902234917
Health Care Provider/Practitioner: KELLY MARIA DORMAN PMHNP

Information about “1902234917” NPI (KELLY MARIA DORMAN PMHNP) exists in 1902234917 in HTML format HTML  |  1902234917 in plain Text format TXT  |  1902234917 in PDF (Portable Document Format) PDF  |  1902234917 in an XML format XML  formats.

NPI Number : 1902234917 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902234917",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DORMAN",
    "FirstName": "KELLY",
    "MiddleName": "MARIA",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "PMHNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "MCNICHOL",
    "OtherFirstName": "KELLY",
    "OtherMiddleName": "MARIA",
    "OtherNamePrefix": "MS.",
    "OtherNameSuffix": null,
    "OtherCredential": "PMHNP",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1021 CHAPEL ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ONEIDA",
    "MailingAddressStateName": "NY",
    "MailingAddressPostalCode": "13421-2837",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1021 CHAPEL ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "ONEIDA",
    "PracticeLocationAddressStateName": "NY",
    "PracticeLocationAddressPostalCode": "13421-2837",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "315-744-6977",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/30/2013",
    "LastUpdateDate": "02/14/2023",
    "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": "163W00000X",
          "TaxonomyName": "Registered Nurse",
          "LicenseNumber": "645763",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "SP022693",
          "LicenseNumberStateCode": "PA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LP0808X",
          "TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
          "LicenseNumber": "401708",
          "LicenseNumberStateCode": "NY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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