{
"Npi": {
"NPI": "1669847067",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "VANDEWATER",
"FirstName": "BRENDA",
"MiddleName": "LYNN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MCCLURE",
"OtherFirstName": "BRENDA",
"OtherMiddleName": "LYNN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "CNP",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "12349 ERSKINE RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HOT SPRINGS",
"MailingAddressStateName": "SD",
"MailingAddressPostalCode": "57747-7508",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "605-745-8910",
"MailingAddressFaxNumber": "605-745-7654",
"FirstLinePracticeLocationAddress": "1201 HIGHWAY 71 S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HOT SPRINGS",
"PracticeLocationAddressStateName": "SD",
"PracticeLocationAddressPostalCode": "57747-8800",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "605-745-8910",
"PracticeLocationAddressFaxNumber": "605-745-7654",
"EnumerationDate": "12/10/2015",
"LastUpdateDate": "12/10/2015",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "CP001015",
"LicenseNumberStateCode": "SD",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}