Active NPI
Nakedra Eunique Gavin, PT,DPT
- Physical Therapist
- Laurel, MS
National Provider Identifier
1316369457
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 24285
- Practice address
- 22 Crosby Dr
Laurel, MS 39440-5413 - Phone
- (601) 433-1228
- NPI assigned
- Jan 8, 2014
- Last updated
- Jan 8, 2014
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 24285 | MD | Primary |
Addresses
Primary practice location
22 Crosby Dr
Laurel, MS 39440-5413
Mailing address
22 Crosby Dr
Laurel, MS 39440-5413
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24285 | MD | MD | Physical Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389139200000",
"number": "1316369457",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22 CROSBY DR",
"city": "LAUREL",
"state": "MS",
"postal_code": "394405413"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22 CROSBY DR",
"city": "LAUREL",
"state": "MS",
"postal_code": "394405413",
"telephone_number": "601-433-1228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVIN",
"first_name": "NAKEDRA",
"middle_name": "EUNIQUE",
"credential": "PT,DPT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-01-08",
"last_updated": "2014-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "MD",
"license": "24285",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Laurel, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.