NPIMap

Organization Active NPI

Willow Pain and Wellness, LLC

  • Pain Clinic/Center
  • Batesville, MS
National Provider Identifier
1104300854
Registry record updated Sep 19, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Clinic/CenterTaxonomy code 261QP3300X
Legal business name
WILLOW PAIN AND WELLNESS, LLC
Practice address
255 Medical Center Dr.
Batesville, MS 38606
Phone
(662) 638-0462
Fax
(866) 658-0083
NPI assigned
Sep 19, 2018
Last updated
Sep 19, 2018By the provider in NPPES
Organization subpart
Yes
Parent organization
WILLOW PAIN & WELLNESS, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 19, 2018

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

Authorized official

Name
Kirk L. Kinard, DONPI 1376740803
Title
Owner/ Medical Director
Phone
(662) 638-0462

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
Pain Clinic/Center 261QP3300X Primary

Addresses

Primary practice location

255 Medical Center Dr.
Batesville, MS 38606

Mailing address

PO Box 2730
Oxford, MS 38655-4200
Phone (662) 638-0462

Other identifiers 1

IdentifierTypeStateIssuer
04159271MedicaidMS

National Provider Directory

National Provider Directory
Part of
Willow Pain and Wellness LLC

Locations

105 John R Lovelace Dr
Ste 3
Batesville, MS 38606
Phone (662) 638-0462

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 9

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": "1537315200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1537315200000",
    "number": "1104300854",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2730",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386554200",
            "telephone_number": "662-638-0462",
            "fax_number": "866-658-0083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 MEDICAL CENTER DR.",
            "city": "BATESVILLE",
            "state": "MS",
            "postal_code": "38606",
            "telephone_number": "662-638-0462",
            "fax_number": "866-658-0083"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILLOW PAIN AND WELLNESS, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WILLOW PAIN & WELLNESS, LLC",
        "enumeration_date": "2018-09-19",
        "last_updated": "2018-09-19",
        "status": "A",
        "authorized_official_last_name": "KINARD",
        "authorized_official_first_name": "KIRK",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER/ MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "662-638-0462",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "261QP3300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Pain",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04159271",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Batesville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2018; 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.