{
"Npi": {
"NPI": "1265034516",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BROUSSARD",
"FirstName": "SHANIKA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1110 COWAN RD.",
"SecondLineMailingAddress": "SUITE B #2014",
"MailingAddressCityName": "GULFPORT",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39507",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "228-254-3037",
"MailingAddressFaxNumber": "228-335-6029",
"FirstLinePracticeLocationAddress": "6163 E LAMAR ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BAY SAINT LOUIS",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39520-8267",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "504-908-5893",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/11/2020",
"LastUpdateDate": "11/11/2020",
"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": "372600000X",
"TaxonomyName": "Adult Companion",
"LicenseNumber": null,
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}