{
"Npi": {
"NPI": "1821519430",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GEORGE",
"FirstName": "SUMMER",
"MiddleName": "WARREN",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CARGILL",
"OtherFirstName": "SUMMER",
"OtherMiddleName": "WARREN",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "FNP-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "603 S BISHOP AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ROLLA",
"MailingAddressStateName": "MO",
"MailingAddressPostalCode": "65401-4314",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "573-458-8899",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "603 S BISHOP AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "ROLLA",
"PracticeLocationAddressStateName": "MO",
"PracticeLocationAddressPostalCode": "65401-4320",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "573-426-4411",
"PracticeLocationAddressFaxNumber": "573-426-4403",
"EnumerationDate": "07/05/2017",
"LastUpdateDate": "10/15/2024",
"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": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "NUR-APRN-LIC-213351",
"LicenseNumberStateCode": "MT",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "AP134323",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "2024028755",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}