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1912631763 NPI number — KELSEY JOAN EVINS ATC

NPI Number: 1912631763
Health Care Provider/Practitioner: KELSEY JOAN EVINS ATC

Information about “1912631763” NPI (KELSEY JOAN EVINS ATC) exists in 1912631763 in HTML format HTML  |  1912631763 in plain Text format TXT  |  1912631763 in PDF (Portable Document Format) PDF  |  1912631763 in an XML format XML  formats.

NPI Number : 1912631763 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1912631763",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EVINS",
    "FirstName": "KELSEY",
    "MiddleName": "JOAN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "ATC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "JOHNSTON, GORBETT",
    "OtherFirstName": "KELSEY",
    "OtherMiddleName": "JOAN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "ATC",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "1116 OFARRELL LN NW",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ORTING",
    "MailingAddressStateName": "WA",
    "MailingAddressPostalCode": "98360-7418",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "541-379-1825",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "121 N DIVISION ST STE 310",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "AUBURN",
    "PracticeLocationAddressStateName": "WA",
    "PracticeLocationAddressPostalCode": "98001-4931",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "253-545-5978",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/15/2022",
    "LastUpdateDate": "07/15/2022",
    "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": "2255A2300X",
        "TaxonomyName": "Athletic Trainer",
        "LicenseNumber": "A160969833",
        "LicenseNumberStateCode": "WA",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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