Active NPI
Angel Isom
- Homemaker
- Olive Branch, MS
National Provider Identifier
1063008985
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Homemaker
- Practice address
- 4615 Dupree Rd.
Olive Branch, MS 38654-5197 - Phone
- (662) 544-2536
- NPI assigned
- Dec 15, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Phlebotomy Technician | 246RP1900X | 22-1648 | MS | |
| Homemaker | 376J00000X | Primary |
Addresses
Primary practice location
4615 Dupree Rd.
Olive Branch, MS 38654-5197
Mailing address
4615 Dupree Rd.
Olive Branch, MS 38654-5197
Phone (662) 544-2536
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 22-1648 | MS | MD | Phlebotomy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1607990400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651449600000",
"number": "1063008985",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4615 DUPREE RD.",
"city": "OLIVE BRANCH",
"state": "MS",
"postal_code": "386545197",
"telephone_number": "662-544-2536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4615 DUPREE RD.",
"city": "OLIVE BRANCH",
"state": "MS",
"postal_code": "386545197",
"telephone_number": "662-544-2536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ISOM",
"first_name": "ANGEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-12-15",
"last_updated": "2022-05-02",
"certification_date": "2022-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "246RP1900X",
"taxonomy_group": "",
"desc": "Technician, Pathology, Phlebotomy",
"state": "MS",
"license": "22-1648",
"primary": false
},
{
"code": "376J00000X",
"taxonomy_group": "",
"desc": "Homemaker",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olive Branch, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.