{
"Npi": {
"NPI": "1912093816",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "GRAVLIN",
"FirstName": "CARA",
"MiddleName": "A",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "ACNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CROWE",
"OtherFirstName": "CARA",
"OtherMiddleName": "A",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "102 W KENWOOD AVE LOWR LEVEL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "DECATUR",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "62526-4368",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "217-545-8000",
"MailingAddressFaxNumber": "217-545-4485",
"FirstLinePracticeLocationAddress": "102 W KENWOOD AVE LOWR LEVEL",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "DECATUR",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "62526-4368",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "217-545-8000",
"PracticeLocationAddressFaxNumber": "217-545-4485",
"EnumerationDate": "10/05/2006",
"LastUpdateDate": "10/26/2020",
"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": "363LA2100X",
"TaxonomyName": "Acute Care Nurse Practitioner",
"LicenseNumber": "209-005882",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}