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1992384341 NPI number — LA'TRINA MONIQUE WITHERSPOON FNP

NPI Number: 1992384341
Health Care Provider/Practitioner: LA'TRINA MONIQUE WITHERSPOON FNP

Information about “1992384341” NPI (LA'TRINA MONIQUE WITHERSPOON FNP) exists in 1992384341 in HTML format HTML  |  1992384341 in plain Text format TXT  |  1992384341 in PDF (Portable Document Format) PDF  |  1992384341 in an XML format XML  formats.

NPI Number : 1992384341 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992384341",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WITHERSPOON",
    "FirstName": "LA'TRINA",
    "MiddleName": "MONIQUE",
    "NamePrefix": "MRS.",
    "NameSuffix": null,
    "Credential": "FNP",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "7528 SPRING SPRUCE LN",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHARLOTTE",
    "MailingAddressStateName": "NC",
    "MailingAddressPostalCode": "28227-1417",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "980-348-4220",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "3310 SISKEY PKWY",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MATTHEWS",
    "PracticeLocationAddressStateName": "NC",
    "PracticeLocationAddressPostalCode": "28105-3222",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "704-849-2271",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/05/2021",
    "LastUpdateDate": "08/09/2021",
    "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": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "WITH-WSMI8",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "5014285",
          "LicenseNumberStateCode": "NC",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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