Faith Family Clinic of Booneville

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

R871985 Issued in MS

Legal business name

FAITH FAMILY CLINIC OF BOONEVILLE

Practice address

2209 N 2ND St
Booneville, MS 38829-7734

Phone

(662) 728-0162

Fax

(662) 728-0326

NPI assigned

Feb 12, 2018

Last updated

Feb 12, 2018By 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

Ms. Amber Janzen, FNPNPI 1255612081

Title

FNP

Phone

(662) 728-0162

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

Practitioners 5

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.

• Amber Leigh Janzen, FNP

  • Family Nurse Practitioner
  • Booneville, MS
  • NPI 1255612081
  Medicare reassignment Care Compare group NPD Authorized official
• Victoria Paden Switcher, FNP-C

  • Family Nurse Practitioner
  • Corinth, MS
  • NPI 1679107650
  Medicare reassignment Care Compare group NPD
• Brandi Jo Lambert, FNP-C

  • Family Nurse Practitioner
  • Booneville, MS
  • NPI 1043269236
  Medicare reassignment NPD
• Jacqueline A Fraiser, CRNP

  • Family Nurse Practitioner
  • Corinth, MS
  • NPI 1629199633
  NPD
• Kelly S. Thornton, FNP

  • Family Nurse Practitioner
  • Booneville, MS
  • NPI 1750492203
  NPD

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

{
    "created_epoch": "1518393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518393600000",
    "number": "1063911485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 N 2ND ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388297734",
            "telephone_number": "662-728-0162",
            "fax_number": "662-728-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 N 2ND ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388297734",
            "telephone_number": "662-728-0162",
            "fax_number": "662-728-0326"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH FAMILY CLINIC OF BOONEVILLE",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-02-12",
        "last_updated": "2018-02-12",
        "status": "A",
        "authorized_official_last_name": "JANZEN",
        "authorized_official_first_name": "AMBER",
        "authorized_official_title_or_position": "FNP",
        "authorized_official_telephone_number": "662-728-0162",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "R871985",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05850217",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erik Ward Dukes, MD
• Renate Eaton, ANP
• Nicholas Heith Elliott, DNP, FNP-BC, PMHNP-B
• Callie A Emmons, BSW
• Encore Rehabilitation, Inc. (Encore Rehab of Booneville)
• Faith Family Clinic, LLC
• Family First Medical Clinic, LLC
• Family Med 101, Inc
• Margaret Fava, FNP
• Joseph H. Feller, MD

• Primary Care Clinic/Center in Booneville, MS
• Providers in Booneville, MS by specialty
• Primary Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.