{
"Npi": {
"NPI": "1164032355",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KOHOUT",
"FirstName": "KRISTOPHER",
"MiddleName": "RYAN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 95559",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GRAPEVINE",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76099-9707",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "405-724-0574",
"MailingAddressFaxNumber": "405-849-4105",
"FirstLinePracticeLocationAddress": "1115 E TYLER ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ATHENS",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75751-2145",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "903-292-5015",
"PracticeLocationAddressFaxNumber": "903-292-5021",
"EnumerationDate": "08/03/2020",
"LastUpdateDate": "10/22/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA17918",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}