{
"Npi": {
"NPI": "1720397417",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BUCK",
"FirstName": "PAMELA",
"MiddleName": "RENA'",
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "PH.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1854 COUNTRY CLUB RD",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "SENATOBIA",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "38668-6378",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "662-560-9443",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "408 W MAIN ST",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "SENATOBIA",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "38668-2153",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "901-827-7303",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "09/29/2010",
"LastUpdateDate": "09/29/2010",
"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": "36-608",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
},
{
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "P0000002293",
"LicenseNumberStateCode": "TN",
"PrimaryTaxonomySwitch": "N"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}