{
"Npi": {
"NPI": "1003414509",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RICHARDSON",
"FirstName": "KATELYN",
"MiddleName": "STALNAKER",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "AGNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "80 LITTLE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BELDEN",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38826-9118",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-419-2105",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "499 GLOSTER CREEK VLG STE G1",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TUPELO",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38801-4751",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "662-377-2663",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/15/2020",
"LastUpdateDate": "11/02/2022",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "905648",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "897205",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}