{
"Npi": {
"NPI": "1619105996",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BEDARD",
"FirstName": "CASEY",
"MiddleName": "L",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "242 HILLENDALE CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SAINT JOHNS",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32259-8530",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-860-9531",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "175 RAINIER LN STE 9",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SAINT JOHNS",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32259-3093",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-860-9531",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "06/25/2009",
"LastUpdateDate": "10/05/2025",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA9105446",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}