{
"Npi": {
"NPI": "1477035749",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CORMIER",
"FirstName": "KELLSEY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "AGPCNP-BC",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9 BUTTERWORTH DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SOMERSET",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "02726-4745",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "339-788-7590",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "475 KILVERT ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WARWICK",
"PracticeLocationAddressStateName": "RI",
"PracticeLocationAddressPostalCode": "02886-1379",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "401-737-6900",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/04/2018",
"LastUpdateDate": "09/04/2018",
"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": "363LG0600X",
"TaxonomyName": "Gerontology Nurse Practitioner",
"LicenseNumber": "APRN01900",
"LicenseNumberStateCode": "RI",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}