Womans Clinic, a Professional Association

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

Legal business name

WOMANS CLINIC, A PROFESSIONAL ASSOCIATION

Practice address

2000 N State St
Clarksdale, MS 38614-6100

Phone

(662) 627-7361

Fax

(662) 627-1158

NPI assigned

Aug 24, 2005

Organization subpart

No

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

Authorized official

Name

Dr. Kushna K Damallie, MD

Title

President

Phone

(662) 627-7361

Specialties & licenses 2

Addresses

Other identifiers 3

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

{
    "created_epoch": "1124841600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576108800000",
    "number": "1043203136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 N STATE ST",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146100",
            "telephone_number": "662-627-7361",
            "fax_number": "662-627-1158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 N STATE ST",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386146100",
            "telephone_number": "662-627-7361",
            "fax_number": "662-627-1158"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOMANS CLINIC, A PROFESSIONAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-24",
        "last_updated": "2019-12-12",
        "certification_date": "2019-12-12",
        "status": "A",
        "authorized_official_last_name": "DAMALLIE",
        "authorized_official_first_name": "KUSHNA",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "662-627-7361",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "MS",
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARK MEDICAID GROUP NUMBER",
            "identifier": "109754002",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08321779",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ARK BCBS GROUP NUMBER",
            "identifier": "8P026",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pamela Wilson, FNP
• Tralezza Meshay Wilson
• William F Wilson Jr., DMD
• Carolyn D Womack, LCSW
• Woman'S Clinic, a Professional Association
• Brian Andrew Woods, PT
• Linda D Wright, RNC
• Rita Wyatt Wright, M.ED.
• Felicia N Yarbrough, MSW
• Samantha Yates, CPSS

• Rural Health Clinic/Center in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Rural Health Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2019; 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.