{
"Npi": {
"NPI": "1598061780",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "KIRK",
"FirstName": "DIANE",
"MiddleName": "CONSTANCE",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PSY.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "KIRK",
"OtherFirstName": "DIANE",
"OtherMiddleName": "C.S.",
"OtherNamePrefix": "DR.",
"OtherNameSuffix": null,
"OtherCredential": "PSY.D.",
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "1616 E 32ND PL",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "TULSA",
"MailingAddressStateName": "OK",
"MailingAddressPostalCode": "74105-2117",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "918-992-7006",
"MailingAddressFaxNumber": "918-749-1841",
"FirstLinePracticeLocationAddress": "3010 S HARVARD AVENUE",
"SecondLinePracticeLocationAddress": "SUITE 110",
"PracticeLocationAddressCityName": "TULSA",
"PracticeLocationAddressStateName": "OK",
"PracticeLocationAddressPostalCode": "74114-6124",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "302-948-6030",
"PracticeLocationAddressFaxNumber": "918-749-1841",
"EnumerationDate": "02/04/2011",
"LastUpdateDate": "10/28/2016",
"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": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "B1-0000315",
"LicenseNumberStateCode": "DE",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "1234",
"LicenseNumberStateCode": "OK",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}