{
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"IsOrgSubpart": "N",
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"OrgName": "TIFFANY BREWER AUDIOLOGY, LLC",
"LastName": null,
"FirstName": null,
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"FirstLineMailingAddress": "204 BEVINS LN STE B",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "GEORGETOWN",
"MailingAddressStateName": "KY",
"MailingAddressPostalCode": "40324-6145",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "204 BEVINS LN STE B",
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"PracticeLocationAddressCityName": "GEORGETOWN",
"PracticeLocationAddressStateName": "KY",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "513-708-7938",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/06/2017",
"LastUpdateDate": "12/11/2017",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "BREWER",
"AuthorizedOfficialFirstName": "TIFFANY",
"AuthorizedOfficialMiddleName": "DANIELLE",
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"AuthorizedOfficialCredential": "AUD",
"AuthorizedOfficialTelephoneNumber": "502-642-4322",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "231H00000X",
"TaxonomyName": "Audiologist",
"LicenseNumber": "100044",
"LicenseNumberStateCode": "KY",
"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."
}
}
}
}