{
"Npi": {
"NPI": "1669867099",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COCKERELL",
"FirstName": "JOHN",
"MiddleName": "ALLEN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "COCKERELL",
"OtherFirstName": "JOHN",
"OtherMiddleName": "A",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "MD",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "4020 RICHARDS RD STE I",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH LITTLE ROCK",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72117-2744",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-917-9693",
"MailingAddressFaxNumber": "501-916-9804",
"FirstLinePracticeLocationAddress": "4020 RICHARDS RD STE I",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH LITTLE ROCK",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72117-2744",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-916-9693",
"PracticeLocationAddressFaxNumber": "501-916-9804",
"EnumerationDate": "04/02/2015",
"LastUpdateDate": "11/12/2025",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "E-11342",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}