{
"Npi": {
"NPI": "1932656311",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "EDWARDS",
"FirstName": "KELLEY",
"MiddleName": "R",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "FNP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "CHAMBERS",
"OtherFirstName": "KELLEY",
"OtherMiddleName": "R",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "801 YORK ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "MANITOWOC",
"MailingAddressStateName": "WI",
"MailingAddressPostalCode": "54220-4630",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "920-663-9008",
"MailingAddressFaxNumber": "920-684-1439",
"FirstLinePracticeLocationAddress": "244 WESTWOOD BLVD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COLUMBUS",
"PracticeLocationAddressStateName": "IN",
"PracticeLocationAddressPostalCode": "47201-5687",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "812-669-0141",
"PracticeLocationAddressFaxNumber": "812-799-7062",
"EnumerationDate": "09/02/2016",
"LastUpdateDate": "11/12/2025",
"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": "363L00000X",
"TaxonomyName": "Nurse Practitioner",
"LicenseNumber": "71006506A",
"LicenseNumberStateCode": "IN",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}