{
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"FirstLineMailingAddress": "2647 CREEKWOOD DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CEDAR HILL",
"MailingAddressStateName": "TX",
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"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "5 CENTERPOINTE DR STE 400",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "LAKE OSWEGO",
"PracticeLocationAddressStateName": "OR",
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"EnumerationDate": "11/29/2022",
"LastUpdateDate": "11/29/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "CROSS-SARVIS",
"AuthorizedOfficialFirstName": "SAMUEL",
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"AuthorizedOfficialCredential": "NP",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "363LP0808X",
"TaxonomyName": "Psychiatric/Mental Health Nurse Practitioner",
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"LicenseNumberStateCode": null,
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}