{
"Npi": {
"NPI": "1982911558",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "YOUNG",
"FirstName": "TIMESHA",
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": "PA-C",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "WIMS",
"OtherFirstName": "TIMESHA",
"OtherMiddleName": "J.",
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": "PA-C",
"OtherLastNameTypeCode": "1",
"FirstLineMailingAddress": "3621 S STATE ST",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "ANN ARBOR",
"MailingAddressStateName": "MI",
"MailingAddressPostalCode": "48108-1633",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "734-647-5299",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "41000 WOODWARD AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "BLOOMFIELD HILLS",
"PracticeLocationAddressStateName": "MI",
"PracticeLocationAddressPostalCode": "48304-5130",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "248-593-6990",
"PracticeLocationAddressFaxNumber": "248-593-5130",
"EnumerationDate": "09/02/2010",
"LastUpdateDate": "09/08/2025",
"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": "363AM0700X",
"TaxonomyName": "Medical Physician Assistant",
"LicenseNumber": "4682",
"LicenseNumberStateCode": "AZ",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "363A00000X",
"TaxonomyName": "Physician Assistant",
"LicenseNumber": "5601010148",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}