{
"Npi": {
"NPI": "1770243768",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ROMERO",
"FirstName": "CHARLA",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "DNP FNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "LYCAN",
"OtherFirstName": "CHARLA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "DNP FNP-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 780",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MORGANTOWN",
"MailingAddressStateName": "WV",
"MailingAddressPostalCode": "26507-0780",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "304-285-7101",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1 MEDICAL CENTER DR",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MORGANTOWN",
"PracticeLocationAddressStateName": "WV",
"PracticeLocationAddressPostalCode": "26506-1200",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "304-598-4000",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/18/2021",
"LastUpdateDate": "08/15/2025",
"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": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "0997201-NP",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "APN.0997201-NP",
"LicenseNumberStateCode": "CO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "122881",
"LicenseNumberStateCode": "WV",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}