{
"Npi": {
"NPI": "1891150629",
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"EIN": null,
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"IsOrgSubpart": "N",
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": "PICAYUNE PEDIATRICS LLC",
"LastName": null,
"FirstName": null,
"MiddleName": null,
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
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"OtherLastName": null,
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"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "1704 W FOURTH AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "PICAYUNE",
"MailingAddressStateName": "MS",
"MailingAddressPostalCode": "39466-3112",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "601-590-1045",
"MailingAddressFaxNumber": null,
"FirstLinePracticeLocationAddress": "200 COUNTRY CLUB RD",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CARRIERE",
"PracticeLocationAddressStateName": "MS",
"PracticeLocationAddressPostalCode": "39426-9037",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "601-590-1045",
"PracticeLocationAddressFaxNumber": null,
"EnumerationDate": "12/21/2015",
"LastUpdateDate": "12/22/2015",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "ALEXANDER",
"AuthorizedOfficialFirstName": "BETTY",
"AuthorizedOfficialMiddleName": "JO",
"AuthorizedOfficialTitle": "OWNER",
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": "CPNP",
"AuthorizedOfficialTelephoneNumber": "601-590-1045",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "305R00000X",
"TaxonomyName": "Preferred Provider Organization",
"LicenseNumber": "R687693",
"LicenseNumberStateCode": "MS",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}