| NPI |
1225533631 |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
| Entity Type Code |
1 |
The city name in the location address of the provider being identified. |
| Provider Last Name Legal Name |
GODLA |
The last name of the provider. If the provider is an individual, this is the legal name. |
| Provider First Name |
KAITLIN |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider First Line Business Practice Location Address |
701 ROCK SPRINGS DR |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
| Provider Business Practice Location Address City Name |
LAS VEGAS |
The first line location address of the provider
being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box. |
| Provider Business Practice Location Address State Name |
NV |
The city name in the location address of the provider being identified. |
| Provider Business Practice Location Address Postal Code |
891283520 |
The State code in the location of the provider
being identified. |
| Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
| Provider Business Practice Location Address Telephone Number |
7027208846 |
The date that a record was last updated or changed. |
| Provider Enumeration Date |
3/27/2018 |
The date the provider was assigned a unique identifier (assigned an NPI). |
| Last Update Date |
3/27/2018 |
The date that a record was last updated or changed. |
| Provider Gender Code |
F |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Healthcare Provider Taxonomy Code 1 |
372500000X |
The license number issued to the provider being identified. The NPS can accommodate
multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’. |
| Healthcare Provider Primary Taxonomy Switch 1 |
N |
|
| Healthcare Provider Taxonomy Code 2 |
372600000X |
|
| Healthcare Provider Primary Taxonomy Switch 2 |
N |
|
| Healthcare Provider Taxonomy Code 3 |
3747A0650X |
|
| Healthcare Provider Primary Taxonomy Switch 3 |
N |
|
| Healthcare Provider Taxonomy Code 4 |
3747P1801X |
|
| Healthcare Provider Primary Taxonomy Switch 4 |
Y |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |
| Healthcare Provider Taxonomy Code 5 |
376J00000X |
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number. |
| Healthcare Provider Primary Taxonomy Switch 5 |
N |
|
| Is Sole Proprietor |
N |
Code indicating whether the provider is operating as a sole proprietor. Codes are: Y = Yes; N = No |