{
"Npi": {
"NPI": "1457020067",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KADLEC",
"FirstName": "LILY",
"MiddleName": "GRACE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "PRIOR",
"OtherFirstName": "LILY",
"OtherMiddleName": "GRACE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "4320 SEMINARY RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ALEXANDRIA",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22304-1535",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "703-504-3167",
"MailingAddressFaxNumber": "703-504-3388",
"FirstLinePracticeLocationAddress": "4320 SEMINARY RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ALEXANDRIA",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22304-1535",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "703-504-3167",
"PracticeLocationAddressFaxNumber": "703-504-3388",
"EnumerationDate": "09/08/2021",
"LastUpdateDate": "11/11/2022",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA2233",
"LicenseNumberStateCode": "ME",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "0110008831",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}