{
"Npi": {
"NPI": "1396376620",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GOSS",
"FirstName": "JILL",
"MiddleName": "D",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "APRN, FNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GOSS",
"OtherFirstName": "JILL",
"OtherMiddleName": "D",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "APRN, FNP-BC",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1133 CHOCORUA RD UNIT 9",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TAMWORTH",
"MailingAddressStateName": "NH",
"MailingAddressPostalCode": "03886-5025",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "603-393-7326",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3073 WHITE MOUNTAIN HWY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH CONWAY",
"PracticeLocationAddressStateName": "NH",
"PracticeLocationAddressPostalCode": "03860-7101",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "603-356-5461",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/27/2020",
"LastUpdateDate": "10/06/2021",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "PENDING",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": "040280-21",
"LicenseNumberStateCode": "NH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "040280-23",
"LicenseNumberStateCode": "NH",
"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."
}
}
}
}