{
"Npi": {
"NPI": "1699423038",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "COOPER",
"FirstName": "KIMBERLY",
"MiddleName": "ANN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PMHNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "FLOYD",
"OtherFirstName": "KIMBERLY",
"OtherMiddleName": "ANN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "101 E ALLEN ST STE 206",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "HENDERSONVILLE",
"MailingAddressStateName": "NC",
"MailingAddressPostalCode": "28792-5091",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "828-606-6990",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "101 E ALLEN ST STE 206",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "HENDERSONVILLE",
"PracticeLocationAddressStateName": "NC",
"PracticeLocationAddressPostalCode": "28792-5091",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "828-606-6990",
"PracticeLocationAddressFaxNumber": "828-372-4580",
"EnumerationDate": "03/15/2022",
"LastUpdateDate": "06/04/2025",
"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": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
"LicenseNumber": "5015963",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}