{
"Npi": {
"NPI": "1639997778",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BRICKETT",
"FirstName": "LAUREN",
"MiddleName": "C",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "87999 SPUR 26 E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PONCA",
"MailingAddressStateName": "NE",
"MailingAddressPostalCode": "68770-7100",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "515-227-1245",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8200 DODGE ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "OMAHA",
"PracticeLocationAddressStateName": "NE",
"PracticeLocationAddressPostalCode": "68114-4113",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "402-955-5400",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/27/2024",
"LastUpdateDate": "01/08/2026",
"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": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": "3152",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "3152",
"LicenseNumberStateCode": "NE",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}