{
"Npi": {
"NPI": "1396913224",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COLLETTE",
"FirstName": "BRYAN",
"MiddleName": "JOSEPH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherOrgNameTypeCode": null,
"OtherLastName": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1510 REES ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BREAUX BRIDGE",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "70517-4310",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "337-332-2730",
"MailingAddressFaxNumber": "337-332-2711",
"FirstLinePracticeLocationAddress": "1510 REES ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BREAUX BRIDGE",
"PracticeLocationAddressStateName": "LA",
"PracticeLocationAddressPostalCode": "70517-4310",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "337-332-2730",
"PracticeLocationAddressFaxNumber": "337-332-2711",
"EnumerationDate": "02/13/2008",
"LastUpdateDate": "04/25/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "171WH0202X",
"TaxonomyName": "Home Modifications Contractor",
"LicenseNumber": "34289",
"LicenseNumberStateCode": "LA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}