{
"Npi": {
"NPI": "1255893434",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WILSON",
"FirstName": "NATASHA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "HAIR LOSS SPECIALIST",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WILLIAMS",
"OtherFirstName": "NATASHA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1008 TIMBERWOOD LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PICAYUNE",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39466-2345",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-347-6112",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "959 MEMORIAL BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PICAYUNE",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39466-4635",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-347-6112",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/05/2019",
"LastUpdateDate": "09/01/2020",
"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": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "515545",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1744P3200X",
"TaxonomyName": "Prosthetics Case Management",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "246RP1900X",
"TaxonomyName": "Phlebotomy Technician",
"LicenseNumber": "H3T8J8P4",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
},
{
"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
]
}
}
}