Central Jackson Medical Clinic, Inc

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R733308 Issued in MS

Legal business name

CENTRAL JACKSON MEDICAL CLINIC, INC

Practice address

514 C E Woodrow Wilson
Jackson, MS 39216-4538

Phone

(601) 981-7198

Fax

(601) 981-6616

NPI assigned

Sep 14, 2009

Last updated

Sep 14, 2009By 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. Iphogenier Barry

Title

President

Phone

(601) 981-7198

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1252886400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252886400000",
    "number": "1285967943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "514 C E WOODROW WILSON",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164538",
            "telephone_number": "601-981-7198",
            "fax_number": "601-981-6616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "514 C E WOODROW WILSON",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392164538",
            "telephone_number": "601-981-7198",
            "fax_number": "601-981-6616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL JACKSON MEDICAL CLINIC, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-14",
        "last_updated": "2009-09-14",
        "status": "A",
        "authorized_official_last_name": "BARRY",
        "authorized_official_first_name": "IPHOGENIER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "601-981-7198",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R733308",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R718637",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Center for Family Life Extensions, Inc.
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• Centerwell Senior Primary Care Ms PC (CenterWell Senior Primary Care-Jackson West)
• Central Jackson Family Medical Clinic
• Central Medical Clinic, P.a.
• Central Mississippi Civic Improvement Association (Jackson Hinds Comprehensive Health Center)
• Central Mississippi Civic Improvement Association (Jackson Hinds Comprehensive Health Center)
• Central Mississippi Civic Improvement Association Inc. (Jackson-Hinds Comprehensive Health Center Mobile Unit 6)
• Central Mississippi Civic Improvement Association Inc. (Jackson-Hinds Comprehensive Health Center)

• Family Nurse Practitioner in Jackson, MS
• Providers in Jackson, 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 Sep 14, 2009; 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.