Mission Primary Care Clinic PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MISSION PRIMARY CARE CLINIC PLLC

Practice address

1901 Mission 66
Vicksburg, MS 39180-3711

Phone

(601) 636-0097

Fax

(601) 629-9969

NPI assigned

Jul 5, 2007

Last updated

May 25, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Bill Fulcher

Title

Adm

Phone

(601) 636-0097

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• John R Barnes, MD

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1205865680
  Medicare reassignment NPD
• Susan A Chiarito, MD

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1871534008
  Medicare reassignment NPD
• John R Ford, MS

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1356363915
  Medicare reassignment NPD
• Denesia Giffin, NP

  • Nurse Practitioner
  • Vicksburg, MS
  • NPI 1568490241
  Medicare reassignment NPD
• Robert L Giffin, MD

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1376584052
  Medicare reassignment NPD
• Joseph L Wilson, M.D.

  • Internal Medicine Physician
  • Vicksburg, MS
  • NPI 1568560530
  Medicare reassignment NPD
• Robert Michael Cannon, M.D.

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1215373139
  NPD
• Jonathan Grey Flowers, D.O.

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1649659731
  NPD
• Christina R Hossley, NP

  • Family Nurse Practitioner
  • Vicksburg, MS
  • NPI 1770863631
  NPD
• Carlos Alberto Latorre, M.D.

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1104088152
  NPD
• Robert C Masterson, DO

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1053358853
  NPD
• Brandon Mizell, M.D.

  • Family Medicine Physician
  • Vicksburg, MS
  • NPI 1649624693
  NPD

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

{
    "created_epoch": "1183593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653436800000",
    "number": "1487852018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1901 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803711",
            "telephone_number": "601-636-0097",
            "fax_number": "601-629-9969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1901 MISSION 66",
            "city": "VICKSBURG",
            "state": "MS",
            "postal_code": "391803711",
            "telephone_number": "601-636-0097",
            "fax_number": "601-629-9969"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION PRIMARY CARE CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-05",
        "last_updated": "2022-05-25",
        "certification_date": "2022-05-25",
        "status": "A",
        "authorized_official_last_name": "FULCHER",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "ADM",
        "authorized_official_telephone_number": "601-636-0097"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R829001",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lameka Q Miller, FNP
• Karyn Milly
• Alys Minckler, OT
• Mind. Body. Spirit. LLC
• Krystal Miracle
• Mississippi CVS Pharmacy LLC (CVS Pharmacy # 10400)
• Mississippi Homecare, LLC
• Mississippi State Department of Health
• Brandon Mizell, M.D.
• Momentum Therapy Services of Mississippi LLC

• Family Medicine Physician in Vicksburg, MS
• Providers in Vicksburg, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.