{
"Npi": {
"NPI": "1942078274",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "FUSTOS",
"FirstName": "KRISTEN",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "MS, RDN, CSP, LD,",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "GOOCH",
"OtherFirstName": "KRISTEN",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "PO BOX 130334",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TAMPA",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33681-0334",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "813-590-7565",
"MailingAddressFaxNumber": "813-219-8055",
"FirstLinePracticeLocationAddress": "PO BOX 130334",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "TAMPA",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33681-0334",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "813-590-7565",
"PracticeLocationAddressFaxNumber": "813-219-8055",
"EnumerationDate": "12/15/2023",
"LastUpdateDate": "04/22/2025",
"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": "133N00000X",
"TaxonomyName": "Nutritionist",
"LicenseNumber": "ND9388",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "174N00000X",
"TaxonomyName": "Lactation Consultant (Non-RN)",
"LicenseNumber": "ALPP-319150",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "133VN1004X",
"TaxonomyName": "Pediatric Nutrition Registered Dietitian",
"LicenseNumber": "86118144",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}