{
"Npi": {
"NPI": "1558663971",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KHALIK",
"FirstName": "KRISTA",
"MiddleName": "NIKIA",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "PMHNP-BC, MSN, RN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "198 BROOKHAVEN DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLAYTON",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "27527-6282",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "516-661-2727",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "198 BROOKHAVEN DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLAYTON",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "27527-6282",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "516-661-2727",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/18/2010",
"LastUpdateDate": "05/12/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
"Gender": "Female",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "5024415",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "346030",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "635350",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": [
{
"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."
},
{
"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."
}
]
}
}
}