{
"Npi": {
"NPI": "1396934451",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "EPPERSON",
"FirstName": "STEPHANIE",
"MiddleName": "J",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "RAYCRAFT",
"OtherFirstName": "STEPHANIE",
"OtherMiddleName": "J",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "801 FOX RUN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HEYWORTH",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61745-9345",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "309-473-2795",
"MailingAddressFaxNumber": "309-473-3216",
"FirstLinePracticeLocationAddress": "801 FOX RUN",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HEYWORTH",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61745-9345",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "309-473-2795",
"PracticeLocationAddressFaxNumber": "309-473-3216",
"EnumerationDate": "10/15/2007",
"LastUpdateDate": "10/24/2025",
"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": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "085-003079",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}