{
"Npi": {
"NPI": "1619704681",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "RAVEN",
"FirstName": "DEIRDRE",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "15500 VOSS RD STE 200-1067",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SUGAR LAND",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77498-4601",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "830-590-0909",
"MailingAddressFaxNumber": "713-575-3889",
"FirstLinePracticeLocationAddress": "15500 VOSS RD STE 200-1067",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SUGAR LAND",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "77498-4601",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "830-590-0909",
"PracticeLocationAddressFaxNumber": "713-575-3889",
"EnumerationDate": "09/16/2024",
"LastUpdateDate": "09/16/2024",
"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": "163WA0400X",
"TaxonomyName": "Addiction (Substance Use Disorder) Registered Nurse",
"LicenseNumber": "717525",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163WA2000X",
"TaxonomyName": "Administrator Registered Nurse",
"LicenseNumber": "717525",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163WC0400X",
"TaxonomyName": "Case Management Registered Nurse",
"LicenseNumber": "717525",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163WC1500X",
"TaxonomyName": "Community Health Registered Nurse",
"LicenseNumber": "717525",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163WC1600X",
"TaxonomyName": "Continuing Education/Staff Development Registered Nurse",
"LicenseNumber": "717525",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163WP0807X",
"TaxonomyName": "Child & Adolescent Psychiatric/Mental Health Registered Nurse",
"LicenseNumber": "717525",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "174H00000X",
"TaxonomyName": "Health Educator",
"LicenseNumber": "717525",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "405300000X",
"TaxonomyName": "Prevention Professional",
"LicenseNumber": "717525",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "163WP0809X",
"TaxonomyName": "Adult Psychiatric/Mental Health Registered Nurse",
"LicenseNumber": "717525",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}