Life'S Journey OBGYN, PC

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

OS014455 Issued in PA

Legal business name

LIFE'S JOURNEY OBGYN, PC

Practice address

190 West Park Avenue
Suite 9
Dubois, PA 15801

Phone

(814) 371-1900

Fax

(814) 503-8568

NPI assigned

Jan 15, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kelly Dawn Duckett, D.O.

Title

Owner

Phone

(814) 371-1900

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/6640/brand/1/csg/1/fhir/r4

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358208000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1362355200000",
    "number": "1689911232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "190 WEST PARK AVENUE",
            "address_2": "SUITE 9",
            "city": "DUBOIS",
            "state": "PA",
            "postal_code": "15801",
            "telephone_number": "814-371-1900",
            "fax_number": "814-503-8568"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "190 WEST PARK AVENUE",
            "address_2": "SUITE 9",
            "city": "DUBOIS",
            "state": "PA",
            "postal_code": "15801",
            "telephone_number": "814-371-1900",
            "fax_number": "814-503-8568"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE'S JOURNEY OBGYN, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-15",
        "last_updated": "2013-03-04",
        "status": "A",
        "authorized_official_last_name": "DUCKETT",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "814-371-1900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "PA",
            "license": "OS014455",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102334099001",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE - PALMETTO",
            "identifier": "P00813924",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Obstetrics & Gynecology Physician in Dubois, PA
• Providers in Dubois, PA by specialty
• Obstetrics & Gynecology Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.