{
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"FirstLineMailingAddress": "504 TEXAS ST STE 200",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SHREVEPORT",
"MailingAddressStateName": "LA",
"MailingAddressPostalCode": "71101-3526",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "833-642-0813",
"FirstLinePracticeLocationAddress": "346 HOMER RD",
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"PracticeLocationAddressCityName": "MINDEN",
"PracticeLocationAddressStateName": "LA",
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"PracticeLocationAddressTelephoneNumber": "318-553-5430",
"PracticeLocationAddressFaxNumber": "833-642-0813",
"EnumerationDate": "04/03/2020",
"LastUpdateDate": "03/16/2023",
"NPIDeactivationReasonCode": null,
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"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "HIPPLER",
"AuthorizedOfficialFirstName": "BRITTANEY",
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": "318-315-7093",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "General Practice Physician",
"LicenseNumber": null,
"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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}
}
}
}