Active NPI
Foot Care Etc LLC
- Family Nurse Practitioner
- Meridian, MS
National Provider Identifier
1407699309
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- Legal business name
- FOOT CARE ETC LLC
- Doing business as
- FOOT CARE ETC LLC
- Practice address
- 3931 Newell Rd
Meridian, MS 39301-1440 - Phone
- (601) 934-8217
- NPI assigned
- Jun 17, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ms. Gloria Jean Jackson, NP
- Title
- Owner
- Phone
- (601) 934-8217
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist | 213E00000X | |||
| Family Nurse Practitioner | 363LF0000X | Primary |
Addresses
Primary practice location
3931 Newell Rd
Meridian, MS 39301-1440
Mailing address
3931 Newell Rd
Meridian, MS 39301-1440
Phone (601) 934-8217
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 09573377 | Medicaid | MS | |
| 297196YJ96 | Other | MS | MEDICARE NUMBER |
Other names 1
- FOOT CARE ETC LLC
National Provider Directory
National Provider DirectoryPractitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Nurse Practitioner
- Collinsville, MS
- NPI 1245213354
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1718582400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1718582400000",
"number": "1407699309",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3931 NEWELL RD",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393011440",
"telephone_number": "601-934-8217"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3931 NEWELL RD",
"city": "MERIDIAN",
"state": "MS",
"postal_code": "393011440",
"telephone_number": "601-934-8217"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOOT CARE ETC LLC",
"organizational_subpart": "NO",
"enumeration_date": "2024-06-17",
"last_updated": "2024-06-17",
"certification_date": "2024-06-17",
"status": "A",
"authorized_official_last_name": "JACKSON",
"authorized_official_first_name": "GLORIA",
"authorized_official_middle_name": "JEAN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "601-934-8217",
"authorized_official_name_prefix": "Ms.",
"authorized_official_credential": "NP"
},
"taxonomies": [
{
"code": "213E00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Podiatrist",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LF0000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Family",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "09573377",
"state": "MS"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE NUMBER",
"identifier": "297196YJ96",
"state": "MS"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "FOOT CARE ETC LLC",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Meridian, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.