Mimi Cleveland Breedlove, CRNA

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

R853077 Issued in MS

Practice address

830 S Gloster
Tupelo, MS 38801

Phone

(662) 377-4394

Fax

(662) 377-7045

NPI assigned

Jul 17, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Mimi C Cleveland Breedlove Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Registered Nurse

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1248393600000",
    "number": "1417974908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3294",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388033294",
            "telephone_number": "662-377-4394",
            "fax_number": "662-377-7045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "830 S GLOSTER",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "38801",
            "telephone_number": "662-377-4394",
            "fax_number": "662-377-7045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BREEDLOVE",
        "first_name": "MIMI",
        "middle_name": "CLEVELAND",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-17",
        "last_updated": "2009-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "MS",
            "license": "R853077",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "430002113",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "009936796",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIMI",
            "last_name": "CLEVELAND BREEDLOVE",
            "middle_name": "C",
            "credential": "CRNA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Monae Branham, MS
• Daniel Lynton Brasfield, M.D.
• William Cary Brawner, M.D.
• Martisa Shondell Braylock, MA
• Breathe LLC
• Charity Brees, NNP-BC
• Ellen Bresee
• Mark Chapin Bresee, MPT, OCS
• Brian Thomas Psy D PLLC
• Alyssa Bridges

• Certified Registered Nurse Anesthetist in Tupelo, MS
• Providers in Tupelo, MS by specialty
• Certified Registered Nurse Anesthetist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2009; 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.