{
"Npi": {
"NPI": "1649995523",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MOORE",
"FirstName": "KELSY",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WETTLAUFER",
"OtherFirstName": "KELSY",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2300 CLEAR CREEK RD STE 203",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KILLEEN",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76549-5404",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "4808 HEATHER LN",
"SecondLinePracticeLocationAddress": "B",
"PracticeLocationAddressCityName": "KILLEEN",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76549",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "254-345-9565",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/04/2022",
"LastUpdateDate": "07/26/2024",
"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": "106S00000X",
"TaxonomyName": "Behavior Technician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}