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1962125179 NPI number — KENNETH OSCAR TAYLOR

NPI Number: 1962125179
Health Care Provider/Practitioner: KENNETH OSCAR TAYLOR

Information about “1962125179” NPI (KENNETH OSCAR TAYLOR) exists in 1962125179 in HTML format HTML  |  1962125179 in plain Text format TXT  |  1962125179 in PDF (Portable Document Format) PDF  |  1962125179 in an XML format XML  formats.

NPI Number : 1962125179 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1962125179",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "TAYLOR",
    "FirstName": "KENNETH",
    "MiddleName": "OSCAR",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "496 BUXTON RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SACO",
    "MailingAddressStateName": "ME",
    "MailingAddressPostalCode": "04072-9511",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "207-286-5489",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "400 WESTERN AVE",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "SOUTH PORTLAND",
    "PracticeLocationAddressStateName": "ME",
    "PracticeLocationAddressPostalCode": "04106-1704",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "120-777-4711",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "09/22/2022",
    "LastUpdateDate": "09/22/2022",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "101YA0400X",
        "TaxonomyName": "Addiction (Substance Use Disorder) Counselor",
        "LicenseNumber": "AD7993",
        "LicenseNumberStateCode": "ME",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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