{
"Npi": {
"NPI": "1952587537",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DICKINSON",
"FirstName": "TERRY",
"MiddleName": "RICHARD",
"NamePrefix": "MR.",
"NameSuffix": null,
"Credential": "CRNA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "9201 MACSWAIN PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SPRINGFIELD",
"MailingAddressStateName": "VA",
"MailingAddressPostalCode": "22153-3904",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "808-779-9290",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "9300 DEWITT LOOP",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "FORT BELVOIR",
"PracticeLocationAddressStateName": "VA",
"PracticeLocationAddressPostalCode": "22060-5285",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "571-231-3224",
"PracticeLocationAddressFaxNumber": "254-286-7326",
"EnumerationDate": "01/14/2008",
"LastUpdateDate": "09/03/2023",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": "0024168857",
"LicenseNumberStateCode": "VA",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "163W00000X",
"TaxonomyName": "Registered Nurse",
"LicenseNumber": "132261-030",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "367500000X",
"TaxonomyName": "Certified Registered Nurse Anesthetist",
"LicenseNumber": "077953",
"LicenseNumberStateCode": "IL",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}