Individual provider Active NPI

Yen Pham Farmer, FNP-BC

  • Family Nurse Practitioner
  • Southaven, MS
National Provider Identifier
1083902613
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R896239 Issued in MS
Practice address
7276 Southcrest Pkwy
Southaven, MS 38671-4760
Phone
(662) 349-6577
Fax
(662) 349-6562
NPI assigned
Jul 18, 2011
Last updated
Aug 4, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R896239 MS Primary

Addresses

Primary practice location

7276 Southcrest Pkwy
Southaven, MS 38671-4760

Mailing address

7276 Southcrest Pkwy
Southaven, MS 38671-4760
Phone (662) 349-6577

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)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
R896239MSMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Spinal Health Care Associates, P.C. PastSince Aug 11, 2009 Accepting new patients
Sidhu Pediatrics, LLC PastSince Aug 6, 2023 Accepting new patients
Sidhu Pediatrics, LLC PastSince Aug 6, 2023 Accepting new patients
Memphis & Shelby County Pediatric Group Past Accepting new patients
Memphis & Shelby County Ped. Group Past Accepting new patients
Memphis Spine and Rehab Center, PLLC PastSince Sep 18, 2017 Accepting new patients
Sidhu Pediatrics, LLC Past Accepting new patients

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691107200000",
    "number": "1083902613",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7276 SOUTHCREST PKWY",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714760",
            "telephone_number": "662-349-6577"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7276 SOUTHCREST PKWY",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714760",
            "telephone_number": "662-349-6577",
            "fax_number": "662-349-6562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FARMER",
        "first_name": "YEN",
        "middle_name": "PHAM",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-18",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R896239",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2023; 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.