{
"Npi": {
"NPI": "1598375412",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "O'KELLY",
"FirstName": "ALYSE",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "115 ROUND HILL RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KENNETT SQUARE",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19348-2607",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "310-418-9518",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "3301 LANCASTER PIKE UNIT 3E-3F",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WILMINGTON",
"PracticeLocationAddressStateName": "DE",
"PracticeLocationAddressPostalCode": "19805-1436",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-803-6560",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "08/05/2020",
"LastUpdateDate": "07/18/2025",
"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": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": "DS042872",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
"LicenseNumber": "G10011591",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}