{"npi":"1417907189","type":"NPI-1","status":"active","name":{"display":"Stacy Johnson NP","other":[{"code":"1","type":"Formerly known as","value":"SIBLE, STACY L"}],"first":"STACY","last":"JOHNSON","middle":"L","credential":"NP"},"specialty":{"primary_taxonomy":"363LF0000X","primary_taxonomy_description":"Family Nurse Practitioner","slug":"family-nurse-practitioner","schema_org_specialty":null,"all":[{"code":"363L00000X","description":"Nurse Practitioner","primary":false,"state":"IN","license":"28140959A"},{"code":"363LF0000X","description":"Family Nurse Practitioner","primary":true,"state":"IN","license":"71002173A"}]},"addresses":[{"purpose":"LOCATION","street_1":"2510 E DUPONT RD STE 226","city":"FORT WAYNE","state":"IN","postal_code":"468251603","country_code":"US","phone":"2604603100"},{"purpose":"MAILING","street_1":"250 N SHADELAND AVE","city":"INDIANAPOLIS","state":"IN","postal_code":"462194959","country_code":"US"}],"license":{"state":"IN","number":"71002173A"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"200846660","state":"IN","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20061213000392","type_code":"14-50","type_desc":"PRACTITIONER - NURSE PRACTITIONER","state":"IN","pac_id":"7719986140"}]},"enumeration_date":"2006-05-11","last_updated":"2023-11-20","_meta":{"source":"NPPES","snapshot_date":"2023-11-20","doc_url":"https://findmynpi.com/api"}}