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1942479753 NPI number — BETHANY ANN WALKER PA-C

NPI Number: 1942479753
Health Care Provider/Practitioner: BETHANY ANN WALKER PA-C

Information about “1942479753” NPI (BETHANY ANN WALKER PA-C) exists in 1942479753 in HTML format HTML  |  1942479753 in plain Text format TXT  |  1942479753 in PDF (Portable Document Format) PDF  |  1942479753 in an XML format XML  formats.

NPI Number : 1942479753 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1942479753",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WALKER",
    "FirstName": "BETHANY",
    "MiddleName": "ANN",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PA-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "BAUMAN",
    "OtherFirstName": "BETHANY",
    "OtherMiddleName": "ANN",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "101 SKYLINE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "RUSSELLVILLE",
    "MailingAddressStateName": "AR",
    "MailingAddressPostalCode": "72801-3363",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "479-968-2345",
    "MailingAddressFaxNumber": "497-890-2497",
    "FirstLinePracticeLocationAddress": "101 SKYLINE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "RUSSELLVILLE",
    "PracticeLocationAddressStateName": "AR",
    "PracticeLocationAddressPostalCode": "72801-3363",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "479-968-2345",
    "PracticeLocationAddressFaxNumber": "497-890-2497",
    "EnumerationDate": "02/26/2008",
    "LastUpdateDate": "02/25/2015",
    "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": "363A00000X",
        "TaxonomyName": "Physician Assistant",
        "LicenseNumber": "PA-361",
        "LicenseNumberStateCode": "AR",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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