{
"Npi": {
"NPI": "1619244696",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KSIAZK",
"FirstName": "DEVON",
"MiddleName": "T",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "RUEN",
"OtherFirstName": "DEVON",
"OtherMiddleName": "T",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "7281 SAWMILL ROAD",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "DUBLIN",
"MailingAddressStateName": "OH",
"MailingAddressPostalCode": "43016",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "614-764-0707",
"MailingAddressFaxNumber": "614-764-1707",
"FirstLinePracticeLocationAddress": "400 ALTAIR PKWY STE 3200",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "WESTERVILLE",
"PracticeLocationAddressStateName": "OH",
"PracticeLocationAddressPostalCode": "43082-7653",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "614-392-5160",
"PracticeLocationAddressFaxNumber": "614-764-1707",
"EnumerationDate": "11/19/2011",
"LastUpdateDate": "01/05/2024",
"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": "50.003412",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}