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1952975591 NPI number — CHEYLA ROMAINE CLARK MPH, MS, CGC

NPI Number: 1952975591
Health Care Provider/Practitioner: CHEYLA ROMAINE CLARK MPH, MS, CGC

Information about “1952975591” NPI (CHEYLA ROMAINE CLARK MPH, MS, CGC) exists in 1952975591 in HTML format HTML  |  1952975591 in plain Text format TXT  |  1952975591 in PDF (Portable Document Format) PDF  |  1952975591 in an XML format XML  formats.

NPI Number : 1952975591 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1952975591",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "CLARK",
    "FirstName": "CHEYLA",
    "MiddleName": "ROMAINE",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "MPH, MS, CGC",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "500 ENERGY WAY APT 4108",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "FORT WORTH",
    "MailingAddressStateName": "TX",
    "MailingAddressPostalCode": "76102-2676",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "770-789-1959",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2201 INWOOD RD",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "DALLAS",
    "PracticeLocationAddressStateName": "TX",
    "PracticeLocationAddressPostalCode": "75390-9323",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "214-645-2563",
    "PracticeLocationAddressFaxNumber": "214-645-2562",
    "EnumerationDate": "05/18/2021",
    "LastUpdateDate": "05/18/2021",
    "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": "170300000X",
        "TaxonomyName": "Genetic Counselor (M.S.)",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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