Kuntry Nurse, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

KUNTRY NURSE, LLC

Doing business as

Kuntry Nurse Telehealth

Practice address

232 Market Street
Suite 259
Flowood, MS 39232-3339

Phone

(601) 310-9784

NPI assigned

Sep 11, 2023

Last updated

Nov 10, 2024By 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

Dametra Mangum, FNPNPI 1740904846

Title

Chief Executive Officer

Phone

(601) 310-9784

Specialties & licenses 1

Addresses

Other names 1

• Kuntry Nurse Telehealth Doing business as

Locations

Practitioners 1

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.

• Dametra Mangum, FNP

  • Family Nurse Practitioner
  • Flowood, MS
  • NPI 1740904846
  NPD Authorized official

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

{
    "created_epoch": "1694390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1731196800000",
    "number": "1548047970",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1252 WEST GOVERNMENT STREET",
            "address_2": "P.O. BOX 2336",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390432336",
            "telephone_number": "601-310-9784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "232 MARKET STREET",
            "address_2": "SUITE 259",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392323339",
            "telephone_number": "601-310-9784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KUNTRY NURSE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-11",
        "last_updated": "2024-11-10",
        "certification_date": "2024-11-10",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "DAMETRA",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "601-310-9784",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kuntry Nurse Telehealth",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kuntry Nurse Telehealth",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Family Nurse Practitioner in Flowood, MS
• Providers in Flowood, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2024; 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.