{
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"FirstLineMailingAddress": "141 MISTY VIEW LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT PETERS",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "636-346-4571",
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"FirstLinePracticeLocationAddress": "303A MID RIVERS MALL DR",
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"PracticeLocationAddressCityName": "SAINT PETERS",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "636-970-0155",
"PracticeLocationAddressFaxNumber": "636-970-0159",
"EnumerationDate": "09/28/2026",
"LastUpdateDate": "09/28/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HOFFMAN",
"AuthorizedOfficialFirstName": "JESSICA",
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"AuthorizedOfficialCredential": "DC",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": null,
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}