{
"Npi": {
"NPI": "1992903983",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "N",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "DEFATTA",
"FirstName": "KIMBERLY",
"MiddleName": "ANN",
"NamePrefix": "MISS",
"NameSuffix": null,
"Credential": "PNP",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "DEFATTA",
"OtherFirstName": "KIMBERLY",
"OtherMiddleName": "ANN",
"OtherNamePrefix": "MISS",
"OtherNameSuffix": null,
"OtherCredential": "PNP",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "5631 226TH ST",
"SecondLineMailingAddress": "APT 1",
"MailingAddressCityName": "OAKLAND GARDENS",
"MailingAddressStateName": "NY",
"MailingAddressPostalCode": "11364-2044",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": null,
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "8268 164TH ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "JAMAICA",
"PracticeLocationAddressStateName": "NY",
"PracticeLocationAddressPostalCode": "11432-1121",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "718-883-4500",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "07/11/2007",
"LastUpdateDate": "07/11/2007",
"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": "363LP0200X",
"TaxonomyName": "Pediatric Nurse Practitioner",
"LicenseNumber": "F381894-1",
"LicenseNumberStateCode": "NY",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}