{
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"FirstLineMailingAddress": "PO BOX 550",
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"MailingAddressCityName": "VANCEBURG",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "41179-0550",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "432 16TH ST",
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"PracticeLocationAddressCityName": "ASHLAND",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "606-324-0128",
"PracticeLocationAddressFaxNumber": "606-326-1372",
"EnumerationDate": "06/19/2014",
"LastUpdateDate": "11/18/2020",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "F",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "04156",
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"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}