Mandisa Fayola McCormick- Nelson, ASSISTIVE CARE PRO

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Practice address

1534 Beecher Dr
Saint Louis, MO 63136-2306

Phone

(131) 422-9122

NPI assigned

Nov 24, 2020

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1606176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611014400000",
    "number": "1356945000",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1534 BEECHER DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631362306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1534 BEECHER DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631362306",
            "telephone_number": "131-422-9122"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3329 California Ave",
            "address_purpose": "LOCATION",
            "city": "Saint Louis",
            "state": "MO",
            "postal_code": "631183001",
            "country_code": "US",
            "telephone_number": "131-422-9122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MCCORMICK- NELSON",
        "first_name": "MANDISA",
        "middle_name": "FAYOLA",
        "credential": "ASSISTIVE CARE PRO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-11-24",
        "last_updated": "2021-01-19",
        "certification_date": "2021-01-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "3747A0650X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Technician, Attendant Care Provider",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mimi_nelson@zohomail.com",
            "affiliation": "N",
            "address_1": "1534 Beecher Dr",
            "city": "Saint Louis",
            "state": "MO",
            "country_code": "US",
            "postal_code": "631362306",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Lauren McCoole, AU.D.
• Brittany Jenee McCord, DO
• Camille Zebelman McCormack, LPC
• Maribeth J McCormack, CRNA
• Stephanie McCormack
• Jeremy James McCormick, MD
• Julie M McCormick
• Kristina Wilson McCormick
• Maggie Steffen McCormick, MD
• Molly Ann McCormick, MD

• Home Health Agency in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Home Health Agency in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 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.