{
"Npi": {
"NPI": "1780191809",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CORYELL",
"FirstName": "TIFFANY",
"MiddleName": "CHAWNTAY",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "RPH",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CRUISE",
"OtherFirstName": "TIFFANY",
"OtherMiddleName": "CHAWNTAY",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "RPH",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "1134 NORTH SCARLETT WAY",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "65802",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "417-861-1800",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1134 NORTH SCARLETT WAY",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SPRINGFIELD",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "65802",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "417-861-1800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "01/10/2018",
"LastUpdateDate": "01/10/2018",
"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": "183500000X",
"TaxonomyName": "Pharmacist",
"LicenseNumber": "2004035733",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}