Full Potential Adult Daycare, LLC

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

Legal business name

FULL POTENTIAL ADULT DAYCARE, LLC

Practice address

405 Highway 51 S
Batesville, MS 38606-2549

Phone

(662) 563-0690

Fax

(662) 563-7304

NPI assigned

Oct 30, 2019

Last updated

Oct 30, 2019By 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

Tamekia Renix Jackson

Title

Ceo

Phone

(662) 563-0690

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1572393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1572393600000",
    "number": "1407490816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 HIGHWAY 51 S",
            "city": "BATESVILLE",
            "state": "MS",
            "postal_code": "386062549",
            "telephone_number": "662-563-0690",
            "fax_number": "662-563-7304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 HIGHWAY 51 S",
            "city": "BATESVILLE",
            "state": "MS",
            "postal_code": "386062549",
            "telephone_number": "662-563-0690",
            "fax_number": "662-563-7304"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FULL POTENTIAL ADULT DAYCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-30",
        "last_updated": "2019-10-30",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "TAMEKIA",
        "authorized_official_middle_name": "RENIX",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "662-563-0690"
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07031582",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Darryl Dewayne Faulkkner, MS
• Thomas Frazee Fleischhauer, MD
• Kimberly Raine Fortner, DMD
• Margaret Fox
• Lillian Frankart, PHD
• Full Potential LLC
• Full Potential Senior Solutions (Full Potential Medical Supply)
• Marcia Rebekah Garrett, FNP
• Lea Andy Garrott, DMD
• Angela Gee, ANGELA MORROW GEE

• Adult Day Care Clinic/Center in Batesville, MS
• Providers in Batesville, MS by specialty
• Adult Day Care Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2019; 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.