{
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"FirstLineMailingAddress": "10223 BROADWAY ST",
"SecondLineMailingAddress": "SUITE P-604",
"MailingAddressCityName": "PEARLAND",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "77584-7880",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "2626 S LOOP W",
"SecondLinePracticeLocationAddress": "SUITE 650M",
"PracticeLocationAddressCityName": "HOUSTON",
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"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/22/2009",
"LastUpdateDate": "09/30/2009",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BERRY",
"AuthorizedOfficialFirstName": "SONIA",
"AuthorizedOfficialMiddleName": "YVETTE",
"AuthorizedOfficialTitle": "DIRECTOR OF PROVIDER SERVICES",
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"AuthorizedOfficialCredential": "FNP-C, APRN",
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"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Nurse Practitioner",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}