{
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"FirstLineMailingAddress": "8813 ARISTIDES DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40258-1735",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "6540 OUTERLOOP STE 6",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LOUISVILLE",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "502-999-2855",
"PracticeLocationAddressFaxNumber": "502-416-1493",
"EnumerationDate": "03/17/2023",
"LastUpdateDate": "12/04/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BRAXTON",
"AuthorizedOfficialFirstName": "TIA",
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"AuthorizedOfficialCredential": "MSN, APRN, PMHNP-BC",
"AuthorizedOfficialTelephoneNumber": "502-999-2855",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}