{
"Npi": {
"NPI": "1134309180",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HAILE",
"FirstName": "SARA",
"MiddleName": "B.",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CUNNINGHAM",
"OtherFirstName": "SARA",
"OtherMiddleName": "B.",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "122 PINNELL ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RIPLEY",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25271-9101",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-373-1578",
"MailingAddressFaxNumber": "304-373-0497",
"FirstLinePracticeLocationAddress": "122 PINNELL ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RIPLEY",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "25271-9101",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-373-1578",
"PracticeLocationAddressFaxNumber": "304-373-0497",
"EnumerationDate": "11/07/2007",
"LastUpdateDate": "01/12/2021",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "0419",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}