{
"Npi": {
"NPI": "1275913626",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "JACKIE BURGESS MIDWIFERY",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7693 S. VIRGINIA ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "RENO",
"MailingAddressStateName": "NV",
"MailingAddressPostalCode": "89511-1114",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "775-430-9241",
"MailingAddressFaxNumber": "775-418-0430",
"FirstLinePracticeLocationAddress": "7693 S. VIRGINIA ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "RENO",
"PracticeLocationAddressStateName": "NV",
"PracticeLocationAddressPostalCode": "89511-1114",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "775-430-9241",
"PracticeLocationAddressFaxNumber": "775-418-0430",
"EnumerationDate": "06/01/2015",
"LastUpdateDate": "06/17/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BURGESS",
"AuthorizedOfficialFirstName": "JACQUELINE",
"AuthorizedOfficialMiddleName": "RENAE",
"AuthorizedOfficialTitle": "OWNER/MIDWIFE",
"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "LM, CPM",
"AuthorizedOfficialTelephoneNumber": "239-699-8718",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "305S00000X",
"TaxonomyName": "Point of Service",
"LicenseNumber": "MW304",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "176B00000X",
"TaxonomyName": "Midwife",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}