{
"Npi": {
"NPI": "1346878485",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "WOHLFAHRT",
"FirstName": "MATTHEW",
"MiddleName": "ZACHARY",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "DNAP, CRNA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "82 BUCKINGHAM DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BELLA VISTA",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72714-3823",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "100 MERCY WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JOPLIN",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "64804-4524",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "417-781-2727",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/01/2020",
"LastUpdateDate": "07/10/2025",
"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": "163WC0200X",
"TaxonomyName": "Critical Care Medicine Registered Nurse",
"LicenseNumber": "R096962",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": "2020023108",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": "0024188074",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}