East Main Family Medical Clinic LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

R853214 Issued in MS

Legal business name

EAST MAIN FAMILY MEDICAL CLINIC LLC

Practice address

1424 E Main St
Tupelo, MS 38804-2956

Phone

(662) 350-3550

Fax

(662) 842-3061

NPI assigned

Jun 15, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rodney Brian Rodgers, FNP

Title

Owner/Nurse Practitioner

Phone

(662) 350-3550

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Acute Care Family Medical Clinic of Verona Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1529020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1599523200000",
    "number": "1003300815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5024 RAYMOND AVE",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388018671",
            "telephone_number": "662-432-0782",
            "fax_number": "662-842-3061"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1424 E MAIN ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388042956",
            "telephone_number": "662-350-3550",
            "fax_number": "662-842-3061"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5024 Raymond Ave",
            "address_purpose": "LOCATION",
            "city": "Tupelo",
            "state": "MS",
            "postal_code": "388018671",
            "country_code": "US",
            "telephone_number": "662-432-0782",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "EAST MAIN FAMILY MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-06-15",
        "last_updated": "2020-09-08",
        "certification_date": "2020-09-08",
        "status": "A",
        "authorized_official_last_name": "RODGERS",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_middle_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER/NURSE PRACTITIONER",
        "authorized_official_telephone_number": "662-350-3550",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R853214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003300815",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COMMERCIAL, BCBS",
            "identifier": "1003300815",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Acute Care Family Medical Clinic of Verona",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jeffery Ryan Earnest, MSN, APRN, FNP-BC
• Jennagrace Earnest
• Jordan Earrey
• Joshua Earrey
• East Heights Pharmacy Inc
• East Main Family Medical Clinic LLC
• Easter Seals Mississippi Inc.
• Emerson Carys Easterling Sowell, PA
• Jessica W Eaton, CFNP
• Rebecca Lenore Eaton, BSWCM

• Nurse Practitioner in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.