NPI Code Detail JSON Logo

1942013289 NPI number — JERICIA G COLVIN MBA

NPI Number: 1942013289
Health Care Provider/Practitioner: JERICIA G COLVIN MBA

Information about “1942013289” NPI (JERICIA G COLVIN MBA) exists in 1942013289 in HTML format HTML  |  1942013289 in plain Text format TXT  |  1942013289 in PDF (Portable Document Format) PDF  |  1942013289 in an XML format XML  formats.

NPI Number : 1942013289 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942013289",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "COLVIN",
    "FirstName": "JERICIA",
    "MiddleName": "G",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MBA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "STEVENS",
    "OtherFirstName": "JERICIA",
    "OtherMiddleName": "G",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "MBA",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "4644 EICHELBERGER AVE",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "DAYTON",
    "MailingAddressStateName": "OH",
    "MailingAddressPostalCode": "45406-2430",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "937-993-8233",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3730 DELPHOS AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DAYTON",
    "PracticeLocationAddressStateName": "OH",
    "PracticeLocationAddressPostalCode": "45417-1647",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "937-263-3556",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "01/30/2025",
    "LastUpdateDate": "01/30/2025",
    "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": "374J00000X",
        "TaxonomyName": "Doula",
        "LicenseNumber": null,
        "LicenseNumberStateCode": "OH",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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