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1972669455 NPI number — RYAN TREVOR PATTERSON DCNP

NPI Number: 1972669455
Health Care Provider/Practitioner: RYAN TREVOR PATTERSON DCNP

Information about “1972669455” NPI (RYAN TREVOR PATTERSON DCNP) exists in 1972669455 in HTML format HTML  |  1972669455 in plain Text format TXT  |  1972669455 in PDF (Portable Document Format) PDF  |  1972669455 in an XML format XML  formats.

NPI Number : 1972669455 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1972669455",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PATTERSON",
    "FirstName": "RYAN",
    "MiddleName": "TREVOR",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "DCNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 3445",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "INDIANAPOLIS",
    "MailingAddressStateName": "IN",
    "MailingAddressPostalCode": "46206-3445",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "812-994-1404",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1600 E SPRINGHILL DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TERRE HAUTE",
    "PracticeLocationAddressStateName": "IN",
    "PracticeLocationAddressPostalCode": "47802-4363",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "812-994-1404",
    "PracticeLocationAddressFaxNumber": "812-742-9420",
    "EnumerationDate": "12/29/2006",
    "LastUpdateDate": "10/07/2020",
    "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": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "AP4948",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "AZ4948",
          "LicenseNumberStateCode": "AZ",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363L00000X",
          "TaxonomyName": "Nurse Practitioner",
          "LicenseNumber": "71001628A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207N00000X",
          "TaxonomyName": "Dermatology Physician",
          "LicenseNumber": "71001628A",
          "LicenseNumberStateCode": "IN",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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