The Pedz Clinic

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

R879688 Issued in MS

Legal business name

THE PEDZ CLINIC

Practice address

610 3Rd St SW
Magee, MS 39111-3994

Phone

(601) 439-7221

Fax

(601) 439-7193

NPI assigned

Dec 22, 2017

Last updated

Aug 7, 2019By 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

Kelli Fewell, PNP-PCNPI 1154684363

Title

Pediatric Nurse Practitioner

Phone

(601) 439-7221

Specialties & licenses 1

Addresses

Other identifiers 2

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

CLIA laboratory certificates

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/19160/brand/1/csg/1/fhir/r4

Practitioners 2

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.

• Kelli S Fewell, NNP

  • Nurse Practitioner
  • Magee, MS
  • NPI 1154684363
  NPD Authorized official
• Brianna McCue, NP

  • Pediatric Nurse Practitioner
  • Magee, MS
  • NPI 1083207005
  NPD (past)

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

{
    "created_epoch": "1513900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565136000000",
    "number": "1538675798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "610 3RD ST SW",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391113994",
            "telephone_number": "601-439-7221",
            "fax_number": "601-439-7193"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "610 3RD ST SW",
            "city": "MAGEE",
            "state": "MS",
            "postal_code": "391113994",
            "telephone_number": "601-439-7221",
            "fax_number": "601-439-7193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE PEDZ CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-22",
        "last_updated": "2019-08-07",
        "status": "A",
        "authorized_official_last_name": "FEWELL",
        "authorized_official_first_name": "KELLI",
        "authorized_official_title_or_position": "PEDIATRIC NURSE PRACTITIONER",
        "authorized_official_telephone_number": "601-439-7221",
        "authorized_official_credential": "PNP-PC"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MS",
            "license": "R879688",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04038362",
            "state": "MS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1154684363",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Evan J Stout, O.D.
• James H Stuard, DMD
• Jonathan Overby Styron, RPH.
• Madeline Klaire Sullivan, DPT
• Stacie Sullivan, PHARMD
• Thomas R. Blackledge, Jr., MD, PA
• Summer Thomas, OTR/L
• Jessica Ellen Tucker, PHARMD
• Venture Hospitalist, LLC
• Frank C Wade Jr., M.D.

• Pediatrics Physician in Magee, MS
• Providers in Magee, MS by specialty
• Pediatrics Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.