{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "WELL LIFE",
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"FirstLineMailingAddress": "1536 PENTWOOD RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BALTIMORE",
"MailingAddressStateName": "MD",
"MailingAddressPostalCode": "21239-4036",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "443-939-5654",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4709 HARFORD RD # 187",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BALTIMORE",
"PracticeLocationAddressStateName": "MD",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "443-840-9626",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/30/2023",
"LastUpdateDate": "03/30/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "WATKINS",
"AuthorizedOfficialFirstName": "ASHLEY",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "CEO",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CRNP PMHNP-BC",
"AuthorizedOfficialTelephoneNumber": "443-939-5654",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}