{
"Npi": {
"NPI": "1780950733",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BRADLEY",
"FirstName": "LAURA",
"MiddleName": "NUGENT",
"NamePrefix": "MRS.",
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "NUGENT",
"OtherFirstName": "LAURA",
"OtherMiddleName": "ANN",
"OtherNamePrefix": "MS.",
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "800 ST. VINCENT'S DRIVE",
"SecondLineMailingAddress": "SUITE 700",
"MailingAddressCityName": "BIRMINGHAM",
"MailingAddressStateName": "AL",
"MailingAddressPostalCode": "35205-1630",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "205-933-8981",
"MailingAddressFaxNumber": "205-930-0746",
"FirstLinePracticeLocationAddress": "800 ST. VINCENT'S DRIVE",
"SecondLinePracticeLocationAddress": "SUITE 700",
"PracticeLocationAddressCityName": "BIRMINGHAM",
"PracticeLocationAddressStateName": "AL",
"PracticeLocationAddressPostalCode": "35205-1630",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "205-933-8981",
"PracticeLocationAddressFaxNumber": "205-930-0746",
"EnumerationDate": "03/23/2012",
"LastUpdateDate": "10/10/2019",
"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": "363AS0400X",
"TaxonomyName": "Surgical Physician Assistant",
"LicenseNumber": "PA-807",
"LicenseNumberStateCode": "AL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}