Active NPI
Terry Family Medical Clinic
- Family Nurse Practitioner
- Terry, MS
National Provider Identifier
1063629376
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- TERRY FAMILY MEDICAL CLINIC
- Practice address
- 120 W Raymond Street
Terry, MS 39170-0970 - Phone
- (601) 878-5115
- Fax
- (601) 878-5164
- NPI assigned
- May 17, 2007
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Gloria Areghan, FNP
- Title
- Owner
- Phone
- (601) 878-5115
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
120 W Raymond Street
Terry, MS 39170-0970
Mailing address
PO Box 370
Terry, MS 39170-0370
Phone (601) 878-5115
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09015232 | Medicaid | MS |
National Provider Directory
National Provider Directory- Tax ID family
- Mid Jackson Family Health Clinic
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Early Intervention Provider Agency
- Jackson, MS
- NPI 1952693848
Locations
970 I 20 Frontage Rd
Jackson, MS 39201
Phone (601) 326-7614
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.
-
- Family Nurse Practitioner
- Jackson, MS
- NPI 1477650869
-
- Family Nurse Practitioner
- Jackson, MS
- NPI 1780802645
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179360000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1063629376",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 370",
"city": "TERRY",
"state": "MS",
"postal_code": "391700370",
"telephone_number": "601-878-5115",
"fax_number": "601-878-5164"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 W RAYMOND STREET",
"city": "TERRY",
"state": "MS",
"postal_code": "391700970",
"telephone_number": "601-878-5115",
"fax_number": "601-878-5164"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "TERRY FAMILY MEDICAL CLINIC",
"organizational_subpart": "NO",
"enumeration_date": "2007-05-17",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "AREGHAN",
"authorized_official_first_name": "GLORIA",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "601-878-5115",
"authorized_official_credential": "FNP"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09015232",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in Terry, MS
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.