{
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"FirstLineMailingAddress": "PO BOX 79254",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHARLOTTE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28271-7061",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "704-907-2934",
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"FirstLinePracticeLocationAddress": "4822 ALBEMARLE RD",
"SecondLinePracticeLocationAddress": "SUITE 200",
"PracticeLocationAddressCityName": "CHARLOTTE",
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"PracticeLocationAddressTelephoneNumber": "704-907-2934",
"PracticeLocationAddressFaxNumber": "704-532-5948",
"EnumerationDate": "04/28/2013",
"LastUpdateDate": "05/02/2013",
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HAYES",
"AuthorizedOfficialFirstName": "HELEN",
"AuthorizedOfficialMiddleName": "BERNICE",
"AuthorizedOfficialTitle": "NURSE PRACTITIONER",
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"AuthorizedOfficialCredential": "FNP-BC, PMHNP-BC",
"AuthorizedOfficialTelephoneNumber": "704-907-2934",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "201021",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}