{
"Npi": {
"NPI": "1770643793",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "ROBERTS",
"FirstName": "WILDER",
"MiddleName": "MAYHALL",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "AUD, CCC-A",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MAYHALL",
"OtherFirstName": "JULIA",
"OtherMiddleName": "WILDER",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "AUD, CCC-A",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3701 DAUPHIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MOBILE",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "36608-1756",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "251-341-3228",
"MailingAddressFaxNumber": "251-341-3371",
"FirstLinePracticeLocationAddress": "3701 DAUPHIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "MOBILE",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "36608-1756",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "251-341-3228",
"PracticeLocationAddressFaxNumber": "251-341-3371",
"EnumerationDate": "12/11/2006",
"LastUpdateDate": "09/10/2024",
"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": "231H00000X",
"TaxonomyName": "Audiologist",
"LicenseNumber": "805A",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}