{
"Npi": {
"NPI": "1265569909",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CLEVELAND",
"FirstName": "KELLIE",
"MiddleName": "KENDRICK",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DDS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4110 FM 407 STE 150",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FLOWER MOUND",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75077-7216",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "940-455-7004",
"MailingAddressFaxNumber": "940-455-7064",
"FirstLinePracticeLocationAddress": "4110 FM 407 STE 150",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FLOWER MOUND",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75077",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "940-455-7004",
"PracticeLocationAddressFaxNumber": "940-455-7064",
"EnumerationDate": "02/28/2007",
"LastUpdateDate": "06/04/2019",
"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": "1223G0001X",
"TaxonomyName": "General Practice Dentistry",
"LicenseNumber": "21699",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}