{
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"FirstLineMailingAddress": "2308 BRANDYWINE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MCKINNEY",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75070-4563",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "3009 E RENNER RD",
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"PracticeLocationAddressCityName": "RICHARDSON",
"PracticeLocationAddressStateName": "TX",
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"PracticeLocationAddressTelephoneNumber": "972-664-0606",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/20/2014",
"LastUpdateDate": "03/31/2014",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "TAYLOR",
"AuthorizedOfficialFirstName": "ALISON",
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"AuthorizedOfficialCredential": "OTR/L,CHT,CKTI",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "174400000X",
"TaxonomyName": "Specialist",
"LicenseNumber": "112012",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"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."
}
}
}
}