{
"Npi": {
"NPI": "1063069466",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TAYLOR",
"FirstName": "WENDELL",
"MiddleName": "REGINALD",
"NamePrefix": "MR.",
"NameSuffix": "JR.",
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 73720",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRBANKS",
"MailingAddressStateName": "AK",
"MailingAddressPostalCode": "99707-3720",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "513-498-2626",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1101 NOBLE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FAIRBANKS",
"PracticeLocationAddressStateName": "AK",
"PracticeLocationAddressPostalCode": "99701-4924",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "907-458-2682",
"PracticeLocationAddressFaxNumber": "907-458-2628",
"EnumerationDate": "08/20/2019",
"LastUpdateDate": "07/01/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"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": "234580",
"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "025228",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}