{
"Npi": {
"NPI": "1669126116",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DILLON",
"FirstName": "KELSI",
"MiddleName": "MARIAH",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "MSW, LGSW",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "HONAKER",
"OtherFirstName": "KELSI",
"OtherMiddleName": "MARIAH",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MSW, LGSW",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 561",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FAIRDALE",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "25839-0561",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-923-9167",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "120 HARPER CT",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BECKLEY",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "25801-2650",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-923-9167",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "02/03/2022",
"LastUpdateDate": "03/11/2024",
"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": "104100000X",
"TaxonomyName": "Social Worker",
"LicenseNumber": "F793709",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}