Elite Faith Mobile Medical Clinic PLLC

Primary specialty

Community Health Clinic/CenterTaxonomy code 261QC1500X

Legal business name

ELITE FAITH MOBILE MEDICAL CLINIC PLLC

Doing business as

Elite Faith Mobile Medical Clinic

Practice address

95 Kyle CT
Gordonsville, VA 22942-6249

Phone

(434) 989-0484

NPI assigned

May 20, 2024

Organization subpart

No

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

Authorized official

Name

Andrea Shepherd, DNP, FNP-CNPI 1699255091

Title

Founder and Ceo

Phone

(434) 989-0484

Specialties & licenses 2

Addresses

Other names 1

• Elite Faith Mobile Medical Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in VA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrea K Shepherd, FNP

  • Family Nurse Practitioner
  • Charlottesville, VA
  • NPI 1699255091
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1716163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1716163200000",
    "number": "1407695653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 KYLE CT",
            "city": "GORDONSVILLE",
            "state": "VA",
            "postal_code": "229426249"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 KYLE CT",
            "city": "GORDONSVILLE",
            "state": "VA",
            "postal_code": "229426249",
            "telephone_number": "434-989-0484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELITE FAITH MOBILE MEDICAL CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-05-20",
        "last_updated": "2024-05-20",
        "certification_date": "2024-05-20",
        "status": "A",
        "authorized_official_last_name": "SHEPHERD",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "FOUNDER AND CEO",
        "authorized_official_telephone_number": "434-989-0484",
        "authorized_official_credential": "DNP, FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elite Faith Mobile Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dolores Carr, ED.D
• Michael Thomas Clayton, M.D.
• David B Cox, M.D.
• David B Cox
• Ricci Deloriea
• Flora J. Woolfolk LLC
• Patricia Leonard Higgins, NP
• Jose Martin Jorge, RRT
• Avivah Knowles, LPC
• Meghan Elise Lopez, CRNP

• Community Health Clinic/Center in Gordonsville, VA
• Providers in Gordonsville, VA by specialty
• Community Health Clinic/Center in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.