Individual provider Active NPI

Katie Vinson

  • Pharmacist
  • Southaven, MS
National Provider Identifier
1689279804
Registry record updated Dec 4, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
E-15544 Issued in MS
Practice address
2945 Goodman Rd E
Southaven, MS 38672-9073
Phone
(662) 772-5859
Fax
(662) 772-5860
NPI assigned
Dec 4, 2020
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 4, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X E-15544 MS Primary

Addresses

Primary practice location

2945 Goodman Rd E
Southaven, MS 38672-9073

Mailing address

2945 Goodman Rd E
Southaven, MS 38672-9073
Phone (662) 772-5859

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
E-15544MSMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Mississippi CVS Pharmacy LLC PastSince Dec 6, 2020 Accepting new patients

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1607040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607040000000",
    "number": "1689279804",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2945 GOODMAN RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386729073",
            "telephone_number": "662-772-5859",
            "fax_number": "662-772-5860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2945 GOODMAN RD E",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386729073",
            "telephone_number": "662-772-5859",
            "fax_number": "662-772-5860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VINSON",
        "first_name": "KATIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-12-04",
        "last_updated": "2020-12-04",
        "certification_date": "2020-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-15544",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Southaven, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 2020; 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.