{
"Npi": {
"NPI": "1942744495",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JOHNSON",
"FirstName": "MELISSA",
"MiddleName": "KAY",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "NP-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "801 ILLINI DRIVE",
"SecondLineMailingAddress": "ECHO QC, LTD",
"MailingAddressCityName": "SILVIS",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "61282-1804",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "309-281-4074",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "5409 N KNOXVILLE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "PEORIA",
"PracticeLocationAddressStateName": "IL",
"PracticeLocationAddressPostalCode": "61614-5069",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "309-691-1069",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/16/2016",
"LastUpdateDate": "10/30/2025",
"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": "A130336",
"LicenseNumberStateCode": "IA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363LF0000X",
"TaxonomyName": "Family Nurse Practitioner",
"LicenseNumber": "F1216074",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}