{
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"FirstLineMailingAddress": "730 GRIGGSTOWN RD",
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"MailingAddressCityName": "CALVERT CITY",
"MailingAddressStateName": "KY",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "805 MAIN ST",
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"PracticeLocationAddressCityName": "BENTON",
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"PracticeLocationAddressCountryCode": "US",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "03/31/2020",
"LastUpdateDate": "03/31/2020",
"NPIDeactivationReasonCode": null,
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"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"LicenseNumber": "017937",
"LicenseNumberStateCode": "KY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}