{
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"FirstLineMailingAddress": "59 RUSH HAVEN DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "THE WOODLANDS",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77381-3229",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "33300 EGYPT LN STE A800",
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"PracticeLocationAddressCityName": "MAGNOLIA",
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"PracticeLocationAddressTelephoneNumber": "936-788-6493",
"PracticeLocationAddressFaxNumber": "844-705-0120",
"EnumerationDate": "02/17/2019",
"LastUpdateDate": "03/04/2022",
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"GenderCode": "F",
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"Taxonomies": {
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"LicenseNumber": "AP140276",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}