Mississippi Medical Clinic

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

MISSISSIPPI MEDICAL CLINIC

Practice address

403 Pine St
Taylorsville, MS 39168-5659

Phone

(601) 452-7080

Fax

(601) 452-7083

NPI assigned

Aug 24, 2021

Last updated

Apr 25, 2022By 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

Mrs. Patty Bullock, NP

Title

NP Managing Partner

Phone

(601) 452-7080

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

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

CLIA laboratory certificates

Practitioners 3

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.

• Patricia Bullock, NP-C

  • Family Nurse Practitioner
  • Taylorsville, MS
  • NPI 1679862817
  Medicare reassignment NPD
• Chante Nicole Ferguson

  • Family Nurse Practitioner
  • Taylorsville, MS
  • NPI 1568074151
  Medicare reassignment NPD
• Angela B. McCallum, FNP

  • Family Nurse Practitioner
  • Magee, MS
  • NPI 1659755676
  Medicare reassignment NPD

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

{
    "created_epoch": "1629763200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1650844800000",
    "number": "1114694536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 PINE ST",
            "city": "TAYLORSVILLE",
            "state": "MS",
            "postal_code": "391685659",
            "telephone_number": "601-452-7080",
            "fax_number": "601-452-7083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 PINE ST",
            "city": "TAYLORSVILLE",
            "state": "MS",
            "postal_code": "391685659",
            "telephone_number": "601-452-7080",
            "fax_number": "601-452-7083"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2170 Simpson Hwy 49",
            "address_purpose": "LOCATION",
            "city": "Mendenhall",
            "state": "MS",
            "postal_code": "39114",
            "country_code": "US",
            "telephone_number": "601-452-7080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MISSISSIPPI MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-24",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-11",
        "status": "A",
        "authorized_official_last_name": "BULLOCK",
        "authorized_official_first_name": "PATTY",
        "authorized_official_title_or_position": "NP MANAGING PARTNER",
        "authorized_official_telephone_number": "601-452-7080",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Jacobs, D.M.D.
• JFMC Taylorsville, LLC
• John R. Harper,MD, PA
• Vera Denise Kennedy-Miller, LMT#392 MASSAGE THEP
• Magee Benevolent Association (John R Harper, MD)
• Mississippi State Department of Health
• Stephen Grant Nichols, MPT
• Off Main Street Medical PLLC
• Sheuna Posey, LCMHT
• Randy's House of Medicine

• Family Nurse Practitioner in Taylorsville, MS
• Providers in Taylorsville, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; 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.