{
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"EIN": null,
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"FirstLineMailingAddress": "25 FIVE LKS",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SULPHUR",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73086-9707",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-622-6810",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "606 CIRCLE TOP DR.",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SULPHUR",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "580-993-0183",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/09/2007",
"LastUpdateDate": "07/09/2007",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171W00000X",
"TaxonomyName": "Contractor",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}