{
"Npi": {
"NPI": "1558241968",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JENNINGS",
"FirstName": "JONATHAN",
"MiddleName": "SCOTT",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "OTA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "464 PAW PAW RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROLAND",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74954-4023",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "479-434-2371",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2220 S WALDRON RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT SMITH",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72903-3761",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "479-434-2371",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/05/2025",
"LastUpdateDate": "09/05/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "224Z00000X",
"TaxonomyName": "Occupational Therapy Assistant",
"LicenseNumber": "OT2025-030",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}