Christ United Medical Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CHRIST UNITED MEDICAL CLINIC LLC

Practice address

2750 N Church Ave
Louisville, MS 39339-2054

Phone

(662) 446-9012

Fax

(662) 446-9432

NPI assigned

May 28, 2019

Organization subpart

No

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

Authorized official

Name

Alyssa Cameron Whitehead, FNP-C

Title

FNP-C, Clinic Administrator

Phone

(662) 446-9012

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Christ United Medical Clinic Other name

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20040/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1559001600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1613001600000",
    "number": "1689231367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9573 HIGHWAY 490",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393399192",
            "telephone_number": "662-446-9012"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2750 N CHURCH AVE",
            "city": "LOUISVILLE",
            "state": "MS",
            "postal_code": "393392054",
            "telephone_number": "662-446-9012",
            "fax_number": "662-446-9432"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHRIST UNITED MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-28",
        "last_updated": "2021-02-11",
        "certification_date": "2021-02-11",
        "status": "A",
        "authorized_official_last_name": "WHITEHEAD",
        "authorized_official_first_name": "ALYSSA",
        "authorized_official_middle_name": "CAMERON",
        "authorized_official_title_or_position": "FNP-C, CLINIC ADMINISTRATOR",
        "authorized_official_telephone_number": "662-446-9012",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN LIC",
            "identifier": "R866227",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Christ United Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Christ United Medical Clinic",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Christ United Medical Clinic",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Kelli R Chunn, ACNP
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• Carol Ann Coleman, MA

• Family Medicine Physician in Louisville, MS
• Providers in Louisville, 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 Feb 11, 2021; 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.