NPIMap

Organization Active NPI

Westside Family Medical Clinic of Tupelo LLC

  • Primary Care Nurse Practitioner
  • Tupelo, MS
National Provider Identifier
1427429992
Registry record updated Oct 9, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
Legal business name
WESTSIDE FAMILY MEDICAL CLINIC OF TUPELO LLC
Practice address
65 S Thomas St
Tupelo, MS 38801-4352
Phone
(813) 712-9638
NPI assigned
Oct 9, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 9, 2015

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

Authorized official

Name
Neil Vickers
Title
Owner
Phone
(813) 712-9638

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LP2300X Primary

Addresses

Primary practice location

65 S Thomas St
Tupelo, MS 38801-4352

Mailing address

65 S Thomas St
Tupelo, MS 38801-4352
Phone (813) 712-9638

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1444348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1444348800000",
    "number": "1427429992",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "65 S THOMAS ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014352",
            "telephone_number": "813-712-9638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "65 S THOMAS ST",
            "city": "TUPELO",
            "state": "MS",
            "postal_code": "388014352",
            "telephone_number": "813-712-9638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WESTSIDE FAMILY MEDICAL CLINIC OF TUPELO LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-09",
        "last_updated": "2015-10-09",
        "status": "A",
        "authorized_official_last_name": "VICKERS",
        "authorized_official_first_name": "NEIL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "813-712-9638"
    },
    "taxonomies": [
        {
            "code": "363LP2300X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Primary Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tupelo, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2015; 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.