NPIMap

Individual provider Active NPI

Caitlin Maree Defazio Williams, NP-C

  • Family Nurse Practitioner
  • Thaxton, MS
National Provider Identifier
1437622909
Registry record updated Apr 15, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
903099 Issued in MS
Practice address
11145 Highway 6 W
Thaxton, MS 38871-9024
Phone
(662) 489-8500
NPI assigned
Jan 8, 2019
Last updated
Apr 15, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 903099 MS Primary

Addresses

Primary practice location

11145 Highway 6 W
Thaxton, MS 38871-9024

Mailing address

128 Calloway Loop
Pontotoc, MS 38863-6102
Phone (662) 317-9783

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200420001847 MS Practitioner - Nurse Practitioner 5395175145 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

4579 S Eason Blvd
Tupelo, MS 38801-6539

806 Garfield St
Tupelo, MS 38801-5749
Phone (662) 377-5395

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Mississippi Medical Center CurrentSince Mar 17, 2020 Accepting new patients
North Mississippi Medical Center Current Accepting new patients
North Mississippi Medcial Center, Inc. CurrentSince Mar 17, 2020 Accepting new patients
North Mississippi Medical Center Inc Current Accepting new patients
Thaxton Family Medical Clinic LLC Past Accepting new patients
North Mississippi Medical Center Family Medicine Past Accepting new patients
Thaxton Medical Clinic, LLC PastSince Dec 4, 2016 Accepting new patients

Locations

4579 S Eason Blvd
Ste A
Tupelo, MS 38801
Phone (662) 377-6161

4579 S Eason Blvd
Ste Ef
Tupelo, MS 38801
Phone (662) 377-7590

806 Garfield St
Tupelo, MS 38801
Phone (662) 377-5395

Interoperability endpoints

  • Direct secure messaging: caitlinwilliams@nmhs.medalliesdirect.net
  • FHIR API: https://api.platform.athenahealth.com/13556/brand/1/csg/1/fhir/r4

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1546905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1586908800000",
    "number": "1437622909",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "128 CALLOWAY LOOP",
            "city": "PONTOTOC",
            "state": "MS",
            "postal_code": "388636102",
            "telephone_number": "662-317-9783"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11145 HIGHWAY 6 W",
            "city": "THAXTON",
            "state": "MS",
            "postal_code": "388719024",
            "telephone_number": "662-489-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "CAITLIN",
        "middle_name": "MAREE DEFAZIO",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-08",
        "last_updated": "2020-04-15",
        "certification_date": "2020-04-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "903099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Thaxton, MS

Sources for this page

Verify at the official NPI Registry.