NPIMap

Organization Active NPI

Kids Avenue Pediatrics LLC

  • Nurse Practitioner
  • Brandon, MS
National Provider Identifier
1154092690
Registry record updated Sep 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
Legal business name
KIDS AVENUE PEDIATRICS LLC
Practice address
1061 Lake Village Cir Ste D1
Brandon, MS 39047-6723
Phone
(601) 941-0699
NPI assigned
Sep 24, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2021

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

Authorized official

Name
Dr. April Dawn Randle, FNPNPI 1699336628
Title
Administrator
Phone
(601) 941-0699

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
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X Primary

Addresses

Primary practice location

1061 Lake Village Cir Ste D1
Brandon, MS 39047-6723

Mailing address

1061 Lake Village Cir Ste D1
Brandon, MS 39047-6723
Phone (601) 941-0699

National Provider Directory

National Provider Directory

Locations

1061 Lake Village Cir
Ste D1
Brandon, MS 39047
Phone (601) 941-0699

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1632441600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1632441600000",
    "number": "1154092690",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1061 LAKE VILLAGE CIR STE D1",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390476723",
            "telephone_number": "601-941-0699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1061 LAKE VILLAGE CIR STE D1",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390476723",
            "telephone_number": "601-941-0699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS AVENUE PEDIATRICS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-24",
        "last_updated": "2021-09-24",
        "certification_date": "2021-09-23",
        "status": "A",
        "authorized_official_last_name": "RANDLE",
        "authorized_official_first_name": "APRIL",
        "authorized_official_middle_name": "DAWN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "601-941-0699",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandon, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2021; 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.