Organization Active NPI

Healthy You Medical Clinic LLC

  • Family Nurse Practitioner
  • Canton, MS
National Provider Identifier
1073390092
Registry record updated Nov 13, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
HEALTHY YOU MEDICAL CLINIC LLC
Practice address
223 W Center St Ste B
Canton, MS 39046-3702
Phone
(601) 407-9955
Fax
(601) 407-9874
NPI assigned
Sep 12, 2023
Last updated
Nov 13, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 13, 2023

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

Authorized official

Name
Brandlynne P Parker, NPNPI 1265189971
Title
Nurse Practitioner
Phone
(601) 407-9955

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NU Primary

Addresses

Primary practice location

223 W Center St Ste B
Canton, MS 39046-3702

Mailing address

PO Box 1064
Canton, MS 39046-1064
Phone (601) 407-9955

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20231120001074 MS Part B Supplier - Clinic/Group Practice 2062860729 Receives reassigned benefits from 1 practitioner
Practice locations: Canton, MS

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2295113Healthy You Medical Clinic LLC223 W Center St Ste B, Canton, MS 39046Certificate of waiverDec 4, 2027

National Provider Directory

National Provider Directory

Locations

223 W Center St
Ste B
Canton, MS 39046
Phone (601) 407-9955

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1694476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1699833600000",
    "number": "1073390092",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1064",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390461064",
            "telephone_number": "601-407-9955",
            "fax_number": "601-407-9874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "223 W CENTER ST STE B",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390463702",
            "telephone_number": "601-407-9955",
            "fax_number": "601-407-9874"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHY YOU MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-12",
        "last_updated": "2023-11-13",
        "certification_date": "2023-11-13",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "BRANDLYNNE",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "NURSE PRACTITIONER",
        "authorized_official_telephone_number": "601-407-9955",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.