{
"Npi": {
"NPI": "1174069421",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MARLOWE",
"FirstName": "MCKINLEY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCMULLIN",
"OtherFirstName": "MCKINLEY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "14601 S PLEASANT VALLEY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KUNA",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83634-2728",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "208-614-6583",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "14601 S PLEASANT VALLEY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KUNA",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83634-2728",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-614-6583",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/10/2017",
"LastUpdateDate": "12/26/2025",
"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": "PA-2542",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}