{
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"FirstLineMailingAddress": "PO BOX 1548",
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"MailingAddressCityName": "HENDERSON",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "42419-1548",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "270-826-9595",
"MailingAddressFaxNumber": "270-826-3656",
"FirstLinePracticeLocationAddress": "1413 N ELM ST",
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"PracticeLocationAddressCityName": "HENDERSON",
"PracticeLocationAddressStateName": "KY",
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"EnumerationDate": "11/17/2010",
"LastUpdateDate": "11/17/2010",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "NUNN",
"AuthorizedOfficialFirstName": "MICHELLE",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "27088269595",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"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."
}
}
}
}