{
"Npi": {
"NPI": "1194322271",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SHANNON",
"FirstName": "RYAN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "PO BOX 242848",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MONTGOMERY",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36124-2848",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-270-9914",
"MailingAddressFaxNumber": "334-270-3195",
"FirstLinePracticeLocationAddress": "1722 PINE ST STE 700",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MONTGOMERY",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36106-1125",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-834-1300",
"PracticeLocationAddressFaxNumber": "334-834-8347",
"EnumerationDate": "10/02/2020",
"LastUpdateDate": "10/02/2020",
"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": "363LA2200X",
"TaxonomyName": "Adult Health Nurse Practitioner",
"LicenseNumber": "1-159336",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": "1-159336",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "1-159336",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}