{
"Npi": {
"NPI": "1649081035",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "QUEZADA DUBOIS",
"FirstName": "STACY",
"MiddleName": "LYNN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "24104 S HORSE HAVEN LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHENEY",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "99004-5103",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "970-978-5329",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "12406 E DESMET AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPOKANE VALLEY",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "99216-2996",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "509-688-0147",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/15/2025",
"LastUpdateDate": "05/15/2025",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "AP61452970",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}