{
"Npi": {
"NPI": "1982011698",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KANE",
"FirstName": "KRISTEN",
"MiddleName": "ELIZABETH",
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WARD",
"OtherFirstName": "KRISTEN",
"OtherMiddleName": "ELIZABETH",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "125 S CLARK ST STE 900",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CHICAGO",
"MailingAddressStateName": "IL",
"MailingAddressPostalCode": "60603-4043",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "151-276-7614",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "982 TIOGUE AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COVENTRY",
"PracticeLocationAddressStateName": "RI",
"PracticeLocationAddressPostalCode": "02816-6116",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "401-821-6800",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/14/2014",
"LastUpdateDate": "04/04/2025",
"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": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA00766",
"LicenseNumberStateCode": "RI",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "3642-23",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "3642",
"LicenseNumberStateCode": "WI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "PA6126",
"LicenseNumberStateCode": "MA",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}