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1932738812 NPI number — KELLY ROSE KIRTEK CAA, RRT

NPI Number: 1932738812
Health Care Provider/Practitioner: KELLY ROSE KIRTEK CAA, RRT

Information about “1932738812” NPI (KELLY ROSE KIRTEK CAA, RRT) exists in 1932738812 in HTML format HTML  |  1932738812 in plain Text format TXT  |  1932738812 in PDF (Portable Document Format) PDF  |  1932738812 in an XML format XML  formats.

NPI Number : 1932738812 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1932738812",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "KIRTEK",
    "FirstName": "KELLY",
    "MiddleName": "ROSE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "CAA, RRT",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "4111 FAIRMOUNT ST UNIT 1011",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DALLAS",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "75219-3303",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "313-820-1388",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1935 MEDICAL DISTRICT DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75235-7701",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-456-7000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/03/2020",
    "LastUpdateDate": "08/23/2022",
    "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": "367H00000X",
        "TaxonomyName": "Anesthesiologist Assistant",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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