{
"Npi": {
"NPI": "1336673946",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOON",
"FirstName": "SAVANNAH",
"MiddleName": "VAUGHN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MOON",
"OtherFirstName": "SAVANNAH",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "NP",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "PO BOX 130",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "WETUMPKA",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36092-0003",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "334-280-0620",
"MailingAddressFaxNumber": "334-280-0625",
"FirstLinePracticeLocationAddress": "1210 7TH ST S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLANTON",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "35045-3724",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "334-514-3848",
"PracticeLocationAddressFaxNumber": "334-280-0625",
"EnumerationDate": "04/20/2017",
"LastUpdateDate": "04/12/2021",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "1-140246",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP2300X",
"TaxonomyName": "Primary Care Nurse Practitioner",
"LicenseNumber": "1-140246",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}