Natchez Pediatric Clinic PLLC

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

Legal business name

NATCHEZ PEDIATRIC CLINIC PLLC

Practice address

136 Jefferson Davis Blvd.
Suite a
Natchez, MS 39120

Phone

(601) 442-5439

Fax

(601) 442-3755

NPI assigned

Sep 26, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James M Mayo

Title

Business Manager

Phone

(601) 442-5439

Specialties & licenses 1

Addresses

Other identifiers 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

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.

• Jennifer Lessley, NP-C

  • Family Nurse Practitioner
  • Natchez, MS
  • NPI 1417202433
  NPD (past)
• Jennifer Vermaelen Russ, M.D.

  • Pediatrics Physician
  • Natchez, MS
  • NPI 1619925666
  NPD (past)
• Danita Ronique Weary, M.D.

  • Pediatrics Physician
  • Natchez, MS
  • NPI 1093763245
  NPD (past)

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1033210315",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17918",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "391227918",
            "telephone_number": "601-442-5439",
            "fax_number": "601-442-3755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "136 JEFFERSON DAVIS BLVD.",
            "address_2": "SUITE A",
            "city": "NATCHEZ",
            "state": "MS",
            "postal_code": "39120",
            "telephone_number": "601-442-5439",
            "fax_number": "601-442-3755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATCHEZ PEDIATRIC CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAYO",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "601-442-5439"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015226",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1445967",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Natchez Medical Foundation Inc.
• Natchez Oncology Center (Caring River Cancer Center)
• Natchez Oncology Clinic Incorporated
• Natchez Opital
• Natchez Pathology Laboratory
• Natchez Podiatry & Foot Surgery PA
• Natchez Podiatry PLLC
• Natchez Regional Anesthesia
• Natchez Regional Clinic (OB GYN Associates of Natchez)
• Natchez Regional Clinic

• Pediatric Adolescent Medicine Physician in Natchez, MS
• Providers in Natchez, MS by specialty
• Pediatric Adolescent Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.