{
"Npi": {
"NPI": "1346418001",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "STACK",
"FirstName": "SHERYL",
"MiddleName": "ANN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "APRN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HOLMES",
"OtherFirstName": "SHERYL",
"OtherMiddleName": "ANN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "APRN",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5200 COMMERCE CROSSING 3RD FL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "LOUISVILLE",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40229",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "502-861-5278",
"MailingAddressFaxNumber": "502-861-5278",
"FirstLinePracticeLocationAddress": "610 E BRANNON RD STE 100",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NICHOLASVILLE",
"PracticeLocationAddressStateName": "KY",
"PracticeLocationAddressPostalCode": "40356-6065",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "859-260-5540",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/15/2008",
"LastUpdateDate": "08/12/2024",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "3005514",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "APN0000013260",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}