{
"Npi": {
"NPI": "1902054604",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KEITH MOORE",
"FirstName": "PATRICIA",
"MiddleName": "ANN",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "ARNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "MOORE",
"OtherFirstName": "PATRICIA",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "ARNP, PA",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "2103 NE 272ND AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CAMAS",
"MailingAddressStateName": "WA",
"MailingAddressPostalCode": "98607-9749",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "360-852-5783",
"MailingAddressFaxNumber": "360-834-4403",
"FirstLinePracticeLocationAddress": "2103 NE 272ND AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CAMAS",
"PracticeLocationAddressStateName": "WA",
"PracticeLocationAddressPostalCode": "98607-9749",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "360-852-5783",
"PracticeLocationAddressFaxNumber": "360-834-4403",
"EnumerationDate": "09/05/2008",
"LastUpdateDate": "03/23/2016",
"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": "AP30000304",
"LicenseNumberStateCode": "WA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "201508595NP-PP",
"LicenseNumberStateCode": "OR",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}