{
"Npi": {
"NPI": "1316867880",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "AXIS PSYCHIATRIC GROUP PLLC",
"LastName": null,
"FirstName": null,
"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": "900 SE 5TH ST STE 22",
"SecondLineMailingAddress": "PMB #41",
"MailingAddressCityName": "BENTONVILLE",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72712-6090",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-252-9467",
"MailingAddressFaxNumber": "479-370-3653",
"FirstLinePracticeLocationAddress": "5204 FRESNO ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT SMITH",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72903",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-600-6140",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/16/2026",
"LastUpdateDate": "07/16/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ANDREWS",
"AuthorizedOfficialFirstName": "LAUREN",
"AuthorizedOfficialMiddleName": "HOPE",
"AuthorizedOfficialTitle": "FOUNDER/ PROVIDER",
"AuthorizedOfficialNamePrefix": "DR.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "DNP, PMHNP-C, FNP-C",
"AuthorizedOfficialTelephoneNumber": "918-575-5878",
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
}
]
},
"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."
}
]
}
}
}