Iris Levon Gathers, CERTIFIED HAIR LOSS

Primary specialty

Prosthetics Case ManagementTaxonomy code 1744P3200X

License

L1709270000753 Issued in FL

Practice address

200 Reid Ave
Port St Joe, FL 32456-1824

Phone

(850) 229-4247

NPI assigned

May 2, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1525219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525219200000",
    "number": "1235628637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1142",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324571142",
            "telephone_number": "850-227-6029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 REID AVE",
            "city": "PORT ST JOE",
            "state": "FL",
            "postal_code": "324561824",
            "telephone_number": "850-229-4247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GATHERS",
        "first_name": "IRIS",
        "middle_name": "LEVON",
        "credential": "CERTIFIED HAIR LOSS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-05-02",
        "last_updated": "2018-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1744P3200X",
            "taxonomy_group": "",
            "desc": "Specialist, Prosthetics Case Management",
            "state": "FL",
            "license": "L1709270000753",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Melissa Sue Finch
• Christine Tracy Fishero-Fazio, BCBA
• Florida Department of Health
• Rachel Ashton Forrest, OTR/L
• Patricia A Fults, MDH
• Geri Care Assisted Living and Rehabilitation Center
• Zoe Gerlach
• Don J. Gibson, MD
• Connie Micheal Greenwood, RN
• John M. Griggs, DNP, FNP-C, CDCES

• Prosthetics Case Management in Port St Joe, FL
• Providers in Port St Joe, FL by specialty
• Prosthetics Case Management in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.