{
"Npi": {
"NPI": "1053975987",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ANDERSON",
"FirstName": "JESSICA",
"MiddleName": "GRACE",
"NamePrefix": "MISS",
"NameSuffix": null,
"Credential": "MS,RD,CSSD,LD,EPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "WOMACK ARMY MEDICAL CENTER 2817 ROCK MERRITT AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT BRAGG",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28310-0001",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "910-907-8116",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2817 ROCK MERRITT AVE",
"SecondLinePracticeLocationAddress": "WOMACK ARMY MEDICAL CENTER",
"PracticeLocationAddressCityName": "FORT BRAGG",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28310-5438",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "910-907-8116",
"PracticeLocationAddressFaxNumber": "910-907-6069",
"EnumerationDate": "04/25/2019",
"LastUpdateDate": "03/20/2025",
"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": "133N00000X",
"TaxonomyName": "Nutritionist",
"LicenseNumber": "08619",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "133V00000X",
"TaxonomyName": "Registered Dietitian",
"LicenseNumber": "LD.08619",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "133N00000X",
"TaxonomyName": "Nutritionist",
"LicenseNumber": "L007668",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}