1902247299 NPI number — ANGELICA FORMO KEECH WHNP-BC,NP-C

NPI Number: 1902247299
Health Care Provider/Practitioner: ANGELICA FORMO KEECH WHNP-BC,NP-C

NPI Number : 1902247299 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1902247299",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KEECH",
    "FirstName": "ANGELICA",
    "MiddleName": "FORMO",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "WHNP-BC,NP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "933 LOUISE AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28204-2147",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "844-866-1866",
    "MailingAddressFaxNumber": "704-987-4250",
    "FirstLinePracticeLocationAddress": "198 HWY 45 NORTH",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PLYMOUTH",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "27962",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "252-793-3023",
    "PracticeLocationAddressFaxNumber": "252-791-3108",
    "EnumerationDate": "07/15/2013",
    "LastUpdateDate": "02/28/2024",
    "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": "363LW0102X",
          "TaxonomyName": "Women's Health Nurse Practitioner",
          "LicenseNumber": "5006257",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LA2200X",
          "TaxonomyName": "Adult Health Nurse Practitioner",
          "LicenseNumber": "5006257",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}