Lafayette Pediatric Clinic

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

17111 Issued in MS

Legal business name

LAFAYETTE PEDIATRIC CLINIC

Practice address

2166 S Lamar Blvd
Oxford, MS 38655-5224

Phone

(662) 236-3939

Fax

(662) 236-3924

NPI assigned

Oct 10, 2007

Organization subpart

No

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

Authorized official

Name

Tanya Jean Fitts, M.D.NPI 1366451049

Title

Owner

Phone

(662) 236-3939

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Tanya Jean Fitts, M.D

  • Pediatrics Physician
  • Oxford, MS
  • NPI 1366451049
  NPD (past) Authorized official
• Anne Kristen Glaser

  • Pediatrics Physician
  • Jackson, MS
  • NPI 1518429976
  NPD (past)
• Dana Brooke Underwood

  • Pediatric Nurse Practitioner
  • Oxford, MS
  • NPI 1972021608
  NPD (past)

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

{
    "created_epoch": "1191974400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268784000000",
    "number": "1144418609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2166 S LAMAR BLVD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555224",
            "telephone_number": "662-236-3939",
            "fax_number": "662-236-3924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2166 S LAMAR BLVD",
            "city": "OXFORD",
            "state": "MS",
            "postal_code": "386555224",
            "telephone_number": "662-236-3939",
            "fax_number": "662-236-3924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAFAYETTE PEDIATRIC CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-10",
        "last_updated": "2010-03-17",
        "status": "A",
        "authorized_official_last_name": "FITTS",
        "authorized_official_first_name": "TANYA",
        "authorized_official_middle_name": "JEAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-236-3939",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "MS",
            "license": "17111",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00125498",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew James Kurz
• Micahel Laborde, CADC
• Lynette Denise Lacey-Godfrey, PH.D., LPC, NCC
• Lafayette Counseling Services LLC
• Lafayette LTC, Inc (Oxford Health & Rehab Center)
• Sonya Lafayette, PTA
• Lauren Nelson Lafferty, PT
• William Robert Lake, M. ED. L. M. F. T.
• Son G Lam, MD
• Joella June Lambert, MD

• Pediatric Adolescent Medicine Physician in Oxford, MS
• Providers in Oxford, MS by specialty
• Pediatric Adolescent Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2010; 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.