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1982205423 NPI number — RONEQUA EVANS NP-C

NPI Number: 1982205423
Health Care Provider/Practitioner: RONEQUA EVANS NP-C

Information about “1982205423” NPI (RONEQUA EVANS NP-C) exists in 1982205423 in HTML format HTML  |  1982205423 in plain Text format TXT  |  1982205423 in PDF (Portable Document Format) PDF  |  1982205423 in an XML format XML  formats.

NPI Number : 1982205423 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1982205423",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "EVANS",
    "FirstName": "RONEQUA",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "NP-C",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "EVANS",
    "OtherFirstName": "RONEQUA",
    "OtherMiddleName": "M",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "NP-C",
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "811 CLUBHOUSE DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "PEARL",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39208-7023",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "601-421-4375",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "811 CLUBHOUSE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "PEARL",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39208-7023",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-421-4375",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "11/02/2020",
    "LastUpdateDate": "11/14/2023",
    "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": "363LF0000X",
        "TaxonomyName": "Family Nurse Practitioner",
        "LicenseNumber": "903828",
        "LicenseNumberStateCode": "MS",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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