{
"Npi": {
"NPI": "1164935599",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ANDERSON",
"FirstName": "KENYATTA",
"MiddleName": "DENISE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "VANCE-ANDERSON",
"OtherFirstName": "KENYATTA",
"OtherMiddleName": "DEVISE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5357 BROADVIEW RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PARMA",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "44134-1607",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "440-263-6120",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "12914 BROADWAY AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GARFIELD HEIGHTS",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "44125-1859",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "216-848-9123",
"PracticeLocationAddressFaxNumber": "216-848-9123",
"EnumerationDate": "11/07/2017",
"LastUpdateDate": "06/16/2023",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "024369",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}