{
"Npi": {
"NPI": "1306403449",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WEAVER",
"FirstName": "KASEY",
"MiddleName": "JOLEE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "550 ORCHARD PARK RD STE A110",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WEST SENECA",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14224-2646",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-650-5720",
"MailingAddressFaxNumber": "716-650-4618",
"FirstLinePracticeLocationAddress": "550 ORCHARD PARK RD STE A110",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WEST SENECA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14224-2646",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-650-5720",
"PracticeLocationAddressFaxNumber": "716-650-4618",
"EnumerationDate": "05/23/2019",
"LastUpdateDate": "03/04/2026",
"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": "207N00000X",
"TaxonomyName": "Dermatology Physician",
"LicenseNumber": "F344622-01",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "344622",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "702580",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}