{
"Npi": {
"NPI": "1801206941",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "LISTER",
"FirstName": "MARY",
"MiddleName": "M",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "RPH,PHARMD,BCPS",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MAXWELL",
"OtherFirstName": "MARY",
"OtherMiddleName": "MARGARET",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "5026 REGENT DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "NASHVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37220-1619",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1310 24TH AVE S",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "NASHVILLE",
"PracticeLocationAddressStateName": "TN",
"PracticeLocationAddressPostalCode": "37212-2637",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "615-873-7760",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "04/29/2014",
"LastUpdateDate": "02/29/2024",
"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": "1835P1200X",
"TaxonomyName": "Pharmacotherapy Pharmacist",
"LicenseNumber": "37375",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}