{
"Npi": {
"NPI": "1366230641",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "NURTURED PSYCHIATRY LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "7655 61ST ST S",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COTTAGE GROVE",
"MailingAddressStateName": "MN",
"MailingAddressPostalCode": "55016-6004",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "651-318-6055",
"MailingAddressFaxNumber": "651-318-6577",
"FirstLinePracticeLocationAddress": "393 DUNLAP ST N STE 400A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT PAUL",
"PracticeLocationAddressStateName": "MN",
"PracticeLocationAddressPostalCode": "55104-4235",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "651-318-6055",
"PracticeLocationAddressFaxNumber": "651-318-6577",
"EnumerationDate": "04/28/2025",
"LastUpdateDate": "04/28/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "RIH-REH",
"AuthorizedOfficialFirstName": "KAREN",
"AuthorizedOfficialMiddleName": "F",
"AuthorizedOfficialTitle": "AUTHORIZED OFFICIAL",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "PMHNP",
"AuthorizedOfficialTelephoneNumber": "651-318-6055",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "2084P0800X",
"TaxonomyName": "Psychiatry Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"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."
}
}
}
}