{
"Npi": {
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"EIN": null,
"IsSoleProprietor": null,
"IsOrgSubpart": "N",
"ParentOrgLBN": null,
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"OrgName": "WISH MEMA",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1433 WIND DANCER TRL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "FORT WORTH",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "76131-5416",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1433 WIND DANCER TRL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT WORTH",
"PracticeLocationAddressStateName": "TX",
"PracticeLocationAddressPostalCode": "76131-5416",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "469-223-9489",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/17/2013",
"LastUpdateDate": "11/17/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "MEMA",
"AuthorizedOfficialFirstName": "WISH",
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": "NURSE PRACTITIONER",
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"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "ACNP",
"AuthorizedOfficialTelephoneNumber": "469-223-9489",
"Taxonomies": {
"Taxonomy": {
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"TaxonomyName": "Health Maintenance Organization",
"LicenseNumber": "742276",
"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}