{
"Npi": {
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"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
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"OrgName": null,
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"FirstName": "PATRICK",
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"NamePrefix": "DR.",
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"Credential": "PH.D.",
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"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4798 HIGHWAY 61 S",
"SecondLineMailingAddress": "SUITE B",
"MailingAddressCityName": "VICKSBURG",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39180-7125",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-630-9300",
"MailingAddressFaxNumber": "601-630-0065",
"FirstLinePracticeLocationAddress": "4798 HIGHWAY 61 S",
"SecondLinePracticeLocationAddress": "SUITE B",
"PracticeLocationAddressCityName": "VICKSBURG",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-630-9300",
"PracticeLocationAddressFaxNumber": "601-630-0065",
"EnumerationDate": "02/20/2008",
"LastUpdateDate": "02/20/2008",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
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"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
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"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "332B00000X",
"TaxonomyName": "Durable Medical Equipment & Medical Supplies",
"LicenseNumber": "07659/11.1",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}