{
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"FirstLineMailingAddress": "435 SECOND STREET TED STEVENS WAY",
"SecondLineMailingAddress": "PO BOX 256",
"MailingAddressCityName": "KOTZEBUE",
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"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "907-442-7648",
"MailingAddressFaxNumber": "907-442-7821",
"FirstLinePracticeLocationAddress": "435 SECOND STREET TED STEVENS WAY",
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"PracticeLocationAddressFaxNumber": "907-442-7821",
"EnumerationDate": "04/17/2007",
"LastUpdateDate": "12/22/2008",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "KULUKHON",
"AuthorizedOfficialFirstName": "SHERRY",
"AuthorizedOfficialMiddleName": "ANN",
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"AuthorizedOfficialNamePrefix": "MS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CCDCI",
"AuthorizedOfficialTelephoneNumber": "907-442-7648",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Counselor",
"LicenseNumber": "3059",
"LicenseNumberStateCode": "AK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
}
}
}
}