{
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"FirstLineMailingAddress": "3119 KINGSMORE DR",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "KNOXVILLE",
"MailingAddressStateName": "TN",
"MailingAddressPostalCode": "37921-1457",
"MailingAddressCountryCode": "US",
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"MailingAddressFaxNumber": "865-630-4071",
"FirstLinePracticeLocationAddress": "3119 KINGSMORE DR",
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"PracticeLocationAddressCityName": "KNOXVILLE",
"PracticeLocationAddressStateName": "TN",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "865-850-5978",
"PracticeLocationAddressFaxNumber": "865-630-4071",
"EnumerationDate": "01/17/2020",
"LastUpdateDate": "03/08/2021",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": "11/22/2020",
"NPIReactivationDate": "03/08/2021",
"GenderCode": "F",
"Gender": "Female",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "164W00000X",
"TaxonomyName": "Licensed Practical Nurse",
"LicenseNumber": "60905",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}