{
"Npi": {
"NPI": "1073284642",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CRAWFORD",
"FirstName": "KOLEAN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NURSE PRACTITIONER",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1628 COUNTY ROAD 2003",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GLEN ROSE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76043-5905",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "254-396-5122",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1308 PALUXY RD STE 303",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GRANBURY",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76048-5609",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-579-3948",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/23/2021",
"LastUpdateDate": "05/03/2022",
"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": "1055114",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}