{
"Npi": {
"NPI": "1629574637",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KELLY",
"FirstName": "WILLIAM",
"MiddleName": "JAMES",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "2725 SAND ARBOR CIR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ORLANDO",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32824-4761",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "407-565-9597",
"MailingAddressFaxNumber": "407-550-3923",
"FirstLinePracticeLocationAddress": "525 ROUTE 73 N STE 117",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MARLTON",
"PracticeLocationAddressStateName": "NJ",
"PracticeLocationAddressPostalCode": "08053-3422",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "407-565-9597",
"PracticeLocationAddressFaxNumber": "407-550-3923",
"EnumerationDate": "03/30/2018",
"LastUpdateDate": "06/03/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "64528",
"LicenseNumberStateCode": "NM",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "11014255",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "262907",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "26NJ00812800",
"LicenseNumberStateCode": "NJ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}