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1992533087 NPI number — AVERY ALEXANDRIA WADDELL

NPI Number: 1992533087
Health Care Provider/Practitioner: AVERY ALEXANDRIA WADDELL

Information about “1992533087” NPI (AVERY ALEXANDRIA WADDELL) exists in 1992533087 in HTML format HTML  |  1992533087 in plain Text format TXT  |  1992533087 in PDF (Portable Document Format) PDF  |  1992533087 in an XML format XML  formats.

NPI Number : 1992533087 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1992533087",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "WADDELL",
    "FirstName": "AVERY",
    "MiddleName": "ALEXANDRIA",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "WADDELL-HOWARD",
    "OtherFirstName": "AVERY",
    "OtherMiddleName": "ALEXANDRIA",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": "5",
    "FirstLineMailingAddress": "3903 N HARRISON ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "SHAWNEE",
    "MailingAddressStateName": "OK",
    "MailingAddressPostalCode": "74804-1426",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "405-585-2971",
    "MailingAddressFaxNumber": "405-585-2983",
    "FirstLinePracticeLocationAddress": "1960 HARPER ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHOCTAW",
    "PracticeLocationAddressStateName": "OK",
    "PracticeLocationAddressPostalCode": "73020-8095",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "405-281-1040",
    "PracticeLocationAddressFaxNumber": "405-585-2983",
    "EnumerationDate": "07/22/2024",
    "LastUpdateDate": "09/04/2024",
    "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": "106S00000X",
        "TaxonomyName": "Behavior Technician",
        "LicenseNumber": "RBT-24-372796",
        "LicenseNumberStateCode": "OK",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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