{
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"FirstLineMailingAddress": "1405 4TH AVE NW # 293",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ARDMORE",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "73401-2708",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "580-319-5306",
"MailingAddressFaxNumber": "580-223-6581",
"FirstLinePracticeLocationAddress": "1005 15TH AVE NW",
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"PracticeLocationAddressCityName": "ARDMORE",
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"PracticeLocationAddressFaxNumber": "580-223-6581",
"EnumerationDate": "03/07/2012",
"LastUpdateDate": "03/07/2012",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "LOUGHRIDGE",
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"AuthorizedOfficialTitle": "PRESIDENT/CEO",
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"AuthorizedOfficialCredential": "ARNP-CNP",
"AuthorizedOfficialTelephoneNumber": "580-319-5306",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "42852",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}