{"npi":"1396828992","type":"NPI-1","status":"active","name":{"display":"Mrs. Jessica Buckley","other":[{"code":"1","type":"Formerly known as","value":"BLOOM, JESSICA ANNE"}],"first":"JESSICA","last":"BUCKLEY","middle":"BLOOM"},"specialty":{"primary_taxonomy":"367500000X","primary_taxonomy_description":"Certified Registered Nurse Anesthetist","slug":"certified-registered-nurse-anesthetist","schema_org_specialty":null,"all":[{"code":"163W00000X","description":"Registered Nurse","primary":false,"state":"WV","license":"61450"},{"code":"367500000X","description":"Certified Registered Nurse Anesthetist","primary":true,"state":"WV","license":"73554"}]},"addresses":[{"purpose":"LOCATION","street_1":"3200 MACCORKLE AVE SE","city":"CHARLESTON","state":"WV","postal_code":"25304","country_code":"US","phone":"3043884077","fax":"3043889852"},{"purpose":"MAILING","street_1":"3 DAWN PLACE","city":"CHARLESTON","state":"WV","postal_code":"25314","country_code":"US","phone":"3043440949"}],"license":{"state":"WV","number":"73554"},"identifiers":[{"type_code":"01","label":"Other","value":"P00274757","state":"WV","issuer":"R MEDICARE"},{"type_code":"05","label":"Medicaid","value":"3810004241","state":"WV","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"I20060123000476","type_code":"14-43","type_desc":"PRACTITIONER - CERTIFIED REGISTERED NURSE ANESTHETIST (CRNA)","state":"WV","pac_id":"2860416468"}]},"enumeration_date":"2006-10-24","last_updated":"2025-09-11","_meta":{"source":"NPPES","snapshot_date":"2025-09-11","doc_url":"https://findmynpi.com/api"}}