{
"Npi": {
"NPI": "1972672293",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "BICKNELL",
"FirstName": "ERNEST",
"MiddleName": "PAUL",
"NamePrefix": "DR.",
"NameSuffix": "III",
"Credential": "PSYD",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BICKNELL",
"OtherFirstName": "SYLVIA",
"OtherMiddleName": "M",
"OtherNamePrefix": "MRS.",
"OtherNameSuffix": null,
"OtherCredential": "CFO",
"OtherLastNameTypeCode": "2",
"FirstLineMailingAddress": "1890 S 14TH ST",
"SecondLineMailingAddress": "SUITE 306",
"MailingAddressCityName": "FERNANDINA BEACH",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "32034-4740",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "904-432-7833",
"MailingAddressFaxNumber": "904-432-7831",
"FirstLinePracticeLocationAddress": "1890 S 14TH ST",
"SecondLinePracticeLocationAddress": "SUITE 306",
"PracticeLocationAddressCityName": "FERNANDINA BEACH",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "32034-4740",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "904-432-7833",
"PracticeLocationAddressFaxNumber": "904-432-7831",
"EnumerationDate": "11/08/2006",
"LastUpdateDate": "07/08/2013",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "103TC0700X",
"TaxonomyName": "Clinical Psychologist",
"LicenseNumber": "PY4456",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": null
}
}