{
"Npi": {
"NPI": "1922960178",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MULLENIX",
"FirstName": "MCKENZIE",
"MiddleName": "J",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "RN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BROOKS",
"OtherFirstName": "MCKENZIE",
"OtherMiddleName": "J",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "RN",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "9700 PERKINS LN",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "OLA",
"MailingAddressStateName": "ID",
"MailingAddressPostalCode": "83657-5014",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "336-269-2714",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "1055 N CURTIS RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BOISE",
"PracticeLocationAddressStateName": "ID",
"PracticeLocationAddressPostalCode": "83706-1309",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "208-367-3223",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "11/25/2025",
"LastUpdateDate": "11/25/2025",
"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": "163WE0003X",
"TaxonomyName": "Emergency Registered Nurse",
"LicenseNumber": "335715",
"LicenseNumberStateCode": "ID",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}