{
"Npi": {
"NPI": "1770735532",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PEACE",
"FirstName": "CARLA",
"MiddleName": "JOBETH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "SHELTON",
"OtherFirstName": "CARLA",
"OtherMiddleName": "JOBETH",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5220 NORTHSHORE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NORTH LITTLE ROCK",
"MailingAddressStateName": "AR",
"MailingAddressPostalCode": "72118-5297",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "501-663-6645",
"MailingAddressFaxNumber": "501-663-4877",
"FirstLinePracticeLocationAddress": "4300 LANDERS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NORTH LITTLE ROCK",
"PracticeLocationAddressStateName": "AR",
"PracticeLocationAddressPostalCode": "72117-2525",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "501-771-1600",
"PracticeLocationAddressFaxNumber": "501-955-2252",
"EnumerationDate": "10/10/2008",
"LastUpdateDate": "04/01/2025",
"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": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "PA-445",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": "0010-01506",
"LicenseNumberStateCode": "NC",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA-445",
"LicenseNumberStateCode": "AR",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}