{
"Npi": {
"NPI": "1336930734",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CONGER",
"FirstName": "KYLE",
"MiddleName": "SPENCER",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "RN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "11360 W BLUE FOX ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BOISE",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83709-6917",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "801-347-0160",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1202 E LOCUST ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "EMMETT",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83617-2715",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-901-3287",
"PracticeLocationAddressFaxNumber": "208-365-3572",
"EnumerationDate": "05/14/2025",
"LastUpdateDate": "05/14/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "51549",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163WE0003X",
"TaxonomyName": "Emergency Registered Nurse",
"LicenseNumber": "51549",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}