{
"Npi": {
"NPI": "1811321102",
"EntityType": "Organization",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "MAIN STREET FAMILY CLINIC APRN-CNP PLLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1201 W MAIN ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "JENKS",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74037-2311",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-518-5770",
"MailingAddressFaxNumber": "918-518-5773",
"FirstLinePracticeLocationAddress": "1201 W MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JENKS",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "74037-2311",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "918-518-5770",
"PracticeLocationAddressFaxNumber": "918-518-5773",
"EnumerationDate": "08/22/2013",
"LastUpdateDate": "12/11/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "SCHROEDER",
"AuthorizedOfficialFirstName": "DEBRA",
"AuthorizedOfficialMiddleName": "BEISTLE",
"AuthorizedOfficialTitle": "FAMILY NURSE PRACTITIONER",
"AuthorizedOfficialNamePrefix": "MRS.",
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "APRN-CNP",
"AuthorizedOfficialTelephoneNumber": "918-518-5770",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "261QP2300X",
"TaxonomyName": "Primary Care Clinic/Center",
"LicenseNumber": "R00035175",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}