{
"Npi": {
"NPI": "1063727204",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "STEVENSON",
"FirstName": "NICOLE",
"MiddleName": "L",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MSN-NPC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BRENNER",
"OtherFirstName": "NICOLE",
"OtherMiddleName": "L",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 1028",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JASPER",
"MailingAddressStateName": "IN",
"MailingAddressPostalCode": "47547-1028",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "812-996-5255",
"MailingAddressFaxNumber": "812-996-8497",
"FirstLinePracticeLocationAddress": "1003 E ILLINOIS ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PETERSBURG",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "47567-8068",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "812-354-3485",
"PracticeLocationAddressFaxNumber": "812-354-3459",
"EnumerationDate": "08/12/2010",
"LastUpdateDate": "06/28/2017",
"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": "71003367A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "71003367A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}