{
"Npi": {
"NPI": "1912256744",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "SMITH",
"FirstName": "SARA",
"MiddleName": "NICOLE",
"NamePrefix": "MS.",
"NameSuffix": null,
"Credential": "NP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "COPLEY",
"OtherFirstName": "SARA",
"OtherMiddleName": "NICOLE",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "2108 E THOMAS RD STE 130",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PHOENIX",
"MailingAddressStateName": "AZ",
"MailingAddressPostalCode": "85016-0008",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "602-933-3124",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "19007 N 67TH AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "GLENDALE",
"PracticeLocationAddressStateName": "AZ",
"PracticeLocationAddressPostalCode": "85308-7179",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "602-933-0016",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/07/2012",
"LastUpdateDate": "09/16/2024",
"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": "363LP0200X",
"TaxonomyName": "Pediatric Nurse Practitioner",
"LicenseNumber": "APRN001966",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0222X",
"TaxonomyName": "Critical Care Pediatric Nurse Practitioner",
"LicenseNumber": "13818-NP",
"LicenseNumberStateCode": "OH",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0222X",
"TaxonomyName": "Critical Care Pediatric Nurse Practitioner",
"LicenseNumber": "APRN001966",
"LicenseNumberStateCode": "NV",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363LP0200X",
"TaxonomyName": "Pediatric Nurse Practitioner",
"LicenseNumber": "309490",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}