{
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"FirstLineMailingAddress": "10822 SW 86TH TER",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "AUGUSTA",
"MailingAddressStateName": "KS",
"MailingAddressPostalCode": "67010-8019",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "785-556-0890",
"MailingAddressFaxNumber": "888-365-6743",
"FirstLinePracticeLocationAddress": "550 S OLIVER ST STE A",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WICHITA",
"PracticeLocationAddressStateName": "KS",
"PracticeLocationAddressPostalCode": "67218-2351",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "316-776-4163",
"PracticeLocationAddressFaxNumber": "888-365-6743",
"EnumerationDate": "09/01/2017",
"LastUpdateDate": "12/23/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "REED",
"AuthorizedOfficialFirstName": "JOSHUA",
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"AuthorizedOfficialCredential": "NP",
"AuthorizedOfficialTelephoneNumber": "316-776-4163",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "76382",
"LicenseNumberStateCode": "KS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}