{
"Npi": {
"NPI": "1669904173",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "TAVAKOLIAN",
"FirstName": "LINDSEY",
"MiddleName": "HOPE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "COCHRAN",
"OtherFirstName": "LINDSEY",
"OtherMiddleName": "HOPE",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "M.D.",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "800 8TH AVE STE 400",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76104-2613",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "817-820-0000",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "521 W SOUTHLAKE BLVD STE 175",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTHLAKE",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76092-6175",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "817-820-0000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/03/2017",
"LastUpdateDate": "08/05/2025",
"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": "208200000X",
"TaxonomyName": "Plastic Surgery Physician",
"LicenseNumber": "U0204",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "390200000X",
"TaxonomyName": "Student in an Organized Health Care Education/Training Program",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "2086S0122X",
"TaxonomyName": "Plastic and Reconstructive Surgery Physician",
"LicenseNumber": "U0204",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}