{
"Npi": {
"NPI": "1396106530",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "HAYNES MEDICAL CLINIC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": "6",
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1009 E WOOD ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PARIS",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "38242-4331",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "731-407-4922",
"MailingAddressFaxNumber": "731-407-4920",
"FirstLinePracticeLocationAddress": "1009 E WOOD ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PARIS",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "38242-4331",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "731-407-4922",
"PracticeLocationAddressFaxNumber": "731-407-4920",
"EnumerationDate": "03/16/2016",
"LastUpdateDate": "03/16/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAYNES WATSON",
"AuthorizedOfficialFirstName": "TERRIE",
"AuthorizedOfficialMiddleName": "B",
"AuthorizedOfficialTitle": "NURSE PRACTITIONER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "APRN-BC, FNP",
"AuthorizedOfficialTelephoneNumber": "731-407-4922",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "12936",
"LicenseNumberStateCode": "TN",
"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."
}
}
}
}