{
"Npi": {
"NPI": "1154502532",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WELLS",
"FirstName": "PAMELA",
"MiddleName": "BEAVER",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DNP, FNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BEAVER",
"OtherFirstName": "PAMELA",
"OtherMiddleName": "SUE",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "FNP-BC",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "255 HOLSTON RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WYTHEVILLE",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "24382-4448",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "276-227-0206",
"MailingAddressFaxNumber": "276-227-0846",
"FirstLinePracticeLocationAddress": "255 HOLSTON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WYTHEVILLE",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "24382-4448",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "276-227-0206",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/14/2007",
"LastUpdateDate": "02/07/2024",
"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": "APN0000012879",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}