{
"Npi": {
"NPI": "1962638999",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "JOHNSON",
"FirstName": "JACK",
"MiddleName": "FRANK",
"NamePrefix": "MR.",
"NameSuffix": "III",
"Credential": "APRN",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "JOHNSON",
"OtherFirstName": "JAY",
"OtherMiddleName": null,
"OtherNamePrefix": "MR.",
"OtherNameSuffix": "III",
"OtherCredential": "APRN",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "724 ARDEN LN",
"SecondLineMailingAddress": "SUITE 100",
"MailingAddressCityName": "ROCK HILL",
"MailingAddressStateName": "SC",
"MailingAddressPostalCode": "29732-2996",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "803-980-7337",
"MailingAddressFaxNumber": "803-980-2229",
"FirstLinePracticeLocationAddress": "724 ARDEN LN",
"SecondLinePracticeLocationAddress": "SUITE 100",
"PracticeLocationAddressCityName": "ROCK HILL",
"PracticeLocationAddressStateName": "SC",
"PracticeLocationAddressPostalCode": "29732-2996",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "803-980-7337",
"PracticeLocationAddressFaxNumber": "803-980-2229",
"EnumerationDate": "06/04/2009",
"LastUpdateDate": "06/04/2009",
"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": "364SP0200X",
"TaxonomyName": "Pediatric Clinical Nurse Specialist",
"LicenseNumber": "3360",
"LicenseNumberStateCode": "SC",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}