{
"Npi": {
"NPI": "1609262278",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BULLOCK",
"FirstName": "JESSICA",
"MiddleName": "ELAINE",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SMITH",
"OtherFirstName": "JESSICA",
"OtherMiddleName": "BULLOCK",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "33 LONO AVE STE 250",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KAHULUI",
"MailingAddressStateName": "HI",
"MailingAddressPostalCode": "96732-1634",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-500-3439",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "33 LONO AVE STE 250",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "KAHULUI",
"PracticeLocationAddressStateName": "HI",
"PracticeLocationAddressPostalCode": "96732-1634",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "808-500-3439",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/10/2015",
"LastUpdateDate": "04/30/2025",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "2240",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "19423",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "2240",
"LicenseNumberStateCode": "HI",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}