Fig Leaf, LLC
Organization Active NPI Nurse Practitioner · Caledonia, MS
NPI 1013426329 · NPPES record last updated May 22, 2018
Key facts
- NPI
- 1013426329
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- R858548 (MS)
- Legal business name
- FIG LEAF, LLC
- Practice address
- 171 South St
Caledonia, MS 39740 - Phone
- (662) 251-7389
- NPI assigned
- Sep 29, 2017
- Organization subpart
- No
Authorized official
- Name
- Amanda Fondren, FNP-C
- Title
- Nurse Practitioner/Owner
- Phone
- (662) 855-0080
Practitioners 2
-
Merry Wells, CNP
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner |
363L00000X | R858548 | MS | Yes |
| Community Health Nurse Practitioner |
363LC1500X | |||
| Family Nurse Practitioner |
363LF0000X | |||
| Primary Care Nurse Practitioner |
363LP2300X |
Addresses
Primary practice location
171 South St
Caledonia, MS 39740
Mailing address
171 South St
Caledonia, MS 39740-8587
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851792626 | Other | NPI |
Other names
- Caledonia Community Clinic
Other providers in Caledonia, MS
- Lee Vester Calvert Jr.
- Clark Drug Company, LLC
- Robert Justin Clark
- Kathryn Comer
- Kelsey Melane Dement
- Misty S Glasgow
- Golden Triangle Family Eye Care, PLLC
- Lisa Jordan Hudson
- Jrco, LLC
- Maegan Mattison
All providers in Caledonia, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.