{
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"FirstLineMailingAddress": "PO BOX 295",
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"MailingAddressCityName": "LOCKESBURG",
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"MailingAddressTelephoneNumber": "870-289-5865",
"MailingAddressFaxNumber": "870-289-6993",
"FirstLinePracticeLocationAddress": "1305 ARKANSAS BLVD STE 104",
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"PracticeLocationAddressCityName": "TEXARKANA",
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"PracticeLocationAddressFaxNumber": "870-648-1306",
"EnumerationDate": "08/19/2021",
"LastUpdateDate": "08/19/2021",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "GAMMON",
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"AuthorizedOfficialCredential": "FNP",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Nurse Practitioner",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}