{
"Npi": {
"NPI": "1669150504",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DOHERTY",
"FirstName": "JESSICA",
"MiddleName": "KRISTINE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PHARMD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MARTIN",
"OtherFirstName": "JESSICA",
"OtherMiddleName": "KRISTINE",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "PHARMD",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2900 12TH AVE N STE 503E",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BILLINGS",
"MailingAddressStateName": "MT",
"MailingAddressPostalCode": "59101-7502",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "406-237-5780",
"MailingAddressFaxNumber": "406-237-5785",
"FirstLinePracticeLocationAddress": "2900 12TH AVE N STE 503E",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BILLINGS",
"PracticeLocationAddressStateName": "MT",
"PracticeLocationAddressPostalCode": "59101-7502",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "406-237-5780",
"PracticeLocationAddressFaxNumber": "406-237-5785",
"EnumerationDate": "07/10/2023",
"LastUpdateDate": "07/10/2023",
"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": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "RPH5976",
"LicenseNumberStateCode": "ND",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "1835P0018X",
"TaxonomyName": "Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist",
"LicenseNumber": "PHA-PHA-LIC-54919",
"LicenseNumberStateCode": "MT",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}