NPIMap

Organization Active NPI

Ageless Men's Health, LLC

  • Family Nurse Practitioner
  • Southaven, MS
National Provider Identifier
1124322474
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
AGELESS MEN'S HEALTH, LLC
Practice address
7111 Southcrest Pkwy
Suite 109
Southaven, MS 38671-4850
Phone
(901) 522-6745
Fax
(901) 522-6748
NPI assigned
Dec 30, 2010
Last updated
Nov 11, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

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

Authorized official

Name
Amanda Wilkinson
Title
Business Operations Director
Phone
(702) 818-0446

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X Primary

Addresses

Primary practice location

7111 Southcrest Pkwy
Suite 109
Southaven, MS 38671-4850

Mailing address

7111 Southcrest Pkwy
Suite 109
Southaven, MS 38671-4850
Phone (901) 522-6745

National Provider Directory

National Provider Directory

Locations

7111 Southcrest Pkwy
Ste 109
Southaven, MS 38671
Phone (662) 349-9116

2257 N Germantown Pkwy
Ste 112
Cordova, TN 38016
Phone (901) 507-8040

Practitioners & affiliated clinicians

Practitioners 4

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": "1293667200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731283200000",
    "number": "1124322474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7111 SOUTHCREST PKWY",
            "address_2": "SUITE 109",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714850",
            "telephone_number": "901-522-6745",
            "fax_number": "901-522-6748"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7111 SOUTHCREST PKWY",
            "address_2": "SUITE 109",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386714850",
            "telephone_number": "901-522-6745",
            "fax_number": "901-522-6748"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AGELESS MEN'S HEALTH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-12-30",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A",
        "authorized_official_last_name": "WILKINSON",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "BUSINESS OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "702-818-0446"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "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 Nov 11, 2024; 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.