{
"Npi": {
"NPI": "1013831908",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MATA",
"FirstName": "NELCY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HERNANDEZ- MATA",
"OtherFirstName": "NELCY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "2404 FM 22 E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JACKSONVILLE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75766-6555",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "430-437-2981",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "123 BUSY BEE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALTO",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75925-6258",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "936-858-2327",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/05/2026",
"LastUpdateDate": "08/05/2026",
"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": "1243670",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}