{
"Npi": {
"NPI": "1790237469",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "CONNOLLY",
"FirstName": "KIM",
"MiddleName": "A",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "67 UNION ST FL 2",
"SecondLineMailingAddress": "CHILD DEVELOPMENT UNIT",
"MailingAddressCityName": "NATICK",
"MailingAddressStateName": "MA",
"MailingAddressPostalCode": "01760-6089",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "508-650-7733",
"MailingAddressFaxNumber": "508-650-7807",
"FirstLinePracticeLocationAddress": "162 CORDAVILLE RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SOUTHBOROUGH",
"PracticeLocationAddressStateName": "MA",
"PracticeLocationAddressPostalCode": "01772-1838",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "508-229-8811",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "10/28/2016",
"LastUpdateDate": "02/04/2020",
"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": "363LP0200X",
"TaxonomyName": "Pediatric Nurse Practitioner",
"LicenseNumber": "RN155278",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}