NPIMap

Organization Active NPI

Fig Leaf, LLC

Doing business as Caledonia Community Clinic

  • Nurse Practitioner
  • Caledonia, MS
National Provider Identifier
1013426329
Registry record updated May 22, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R858548 Issued in MS
Legal business name
FIG LEAF, LLC
Doing business as
Caledonia Community Clinic
Practice address
171 South St
Caledonia, MS 39740
Phone
(662) 251-7389
NPI assigned
Sep 29, 2017
Last updated
May 22, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 22, 2018

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

Authorized official

Name
Amanda Fondren, FNP-C
Title
Nurse Practitioner/Owner
Phone
(662) 855-0080

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363L00000X R858548 MS Primary
Community Health Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LC1500X
Family Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LF0000X
Primary Care Nurse PractitionerGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 363LP2300X

Addresses

Primary practice location

171 South St
Caledonia, MS 39740

Mailing address

171 South St
Caledonia, MS 39740-8587

Other names 1

  • Caledonia Community Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1506643200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526947200000",
    "number": "1013426329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "171 SOUTH ST",
            "city": "CALEDONIA",
            "state": "MS",
            "postal_code": "397408587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "171 SOUTH ST",
            "city": "CALEDONIA",
            "state": "MS",
            "postal_code": "39740",
            "telephone_number": "662-251-7389"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIG LEAF, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-29",
        "last_updated": "2018-05-22",
        "status": "A",
        "authorized_official_last_name": "FONDREN",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "NURSE PRACTITIONER/OWNER",
        "authorized_official_telephone_number": "662-855-0080",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R858548",
            "primary": true
        },
        {
            "code": "363LC1500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Caledonia Community Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Caledonia, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; 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.