{
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"FirstLineMailingAddress": "314 EAST ST",
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"FirstLinePracticeLocationAddress": "2311 OHIO AVE STE B",
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"EnumerationDate": "03/26/2021",
"LastUpdateDate": "10/10/2023",
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"NPIReactivationDate": null,
"GenderCode": null,
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"AuthorizedOfficialLastName": "HIGHLEY",
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"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "261QP2000X",
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},
{
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}
]
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}