{
"Npi": {
"NPI": "1629232681",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FRYDRYCH",
"FirstName": "TERA",
"MiddleName": "S",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KILGORE",
"OtherFirstName": "TERA",
"OtherMiddleName": "S",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "621 KELLY BLVD",
"SecondLineMailingAddress": "PO BOX 143",
"MailingAddressCityName": "SLIPPERY ROCK",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "16057-8523",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "724-794-4009",
"MailingAddressFaxNumber": "724-794-4099",
"FirstLinePracticeLocationAddress": "875 N HERMITAGE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HERMITAGE",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "16148-3278",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "724-342-1530",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/17/2008",
"LastUpdateDate": "01/28/2025",
"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": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "MA053134",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}