{
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"FirstLineMailingAddress": "1242 HOCKMAN PIKE",
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"MailingAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": "276-322-1514",
"EnumerationDate": "11/02/2007",
"LastUpdateDate": "03/04/2013",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LARSEN",
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"AuthorizedOfficialCredential": "M.S.,FFFA",
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"Taxonomy": {
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"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}