{
"Npi": {
"NPI": "1972700888",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "HENLEY",
"FirstName": "JEWELL",
"MiddleName": "ANN",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "MD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "184 BARTON ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "BUFFALO",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "14213-1573",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "716-348-3000",
"MailingAddressFaxNumber": "716-881-6247",
"FirstLinePracticeLocationAddress": "100 HIGH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BUFFALO",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "14203-1126",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "716-859-5600",
"PracticeLocationAddressFaxNumber": "716-630-1348",
"EnumerationDate": "07/03/2007",
"LastUpdateDate": "03/30/2020",
"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": "207Q00000X",
"TaxonomyName": "Family Medicine Physician",
"LicenseNumber": "278784",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}