{
"Npi": {
"NPI": "1447748413",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BISHOP",
"FirstName": "KIMBALL",
"MiddleName": "LAMAR",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PTA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "5579 FM 132",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CROCKETT",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "75835-7695",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "936-545-7774",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5579 FM 132",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CROCKETT",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "75835-7695",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "936-545-7774",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/25/2018",
"LastUpdateDate": "04/25/2018",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "2060688",
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "225200000X",
"TaxonomyName": "Physical Therapy Assistant",
"LicenseNumber": "2060688",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}