Puckett Family Medical Clinic

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

PUCKETT FAMILY MEDICAL CLINIC

Practice address

6455 Highway 18
Brandon, MS 39042-7536

Phone

(601) 824-9490

Fax

(601) 824-5855

NPI assigned

Aug 16, 2020

Organization subpart

No

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

Authorized official

Name

Ashely M Shivers, NP

Title

Owner

Phone

(601) 824-9490

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ashley Murphy Shivers, F.N.P.

  • Family Nurse Practitioner
  • Morton, MS
  • NPI 1184958753
  NPD

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

{
    "created_epoch": "1597536000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597536000000",
    "number": "1689285249",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 580",
            "city": "PUCKETT",
            "state": "MS",
            "postal_code": "391510580",
            "telephone_number": "601-824-9490",
            "fax_number": "601-824-5855"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6455 HIGHWAY 18",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390427536",
            "telephone_number": "601-824-9490",
            "fax_number": "601-824-5855"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUCKETT FAMILY MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-16",
        "last_updated": "2020-08-16",
        "certification_date": "2020-08-16",
        "status": "A",
        "authorized_official_last_name": "SHIVERS",
        "authorized_official_first_name": "ASHELY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-824-9490",
        "authorized_official_credential": "NP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emoni Victoria Price, P-LPC
• Ayana Pride
• Providence Pediatric Therapy, LLC
• Margaret Lowery Pruitt, M.S., CCC/SLP
• Puckett Family Dentistry
• Puckett Medical Clinic
• Marilyn Marie Purvis
• Michelle Leigh Purvis, OTR/L
• Quad Intermed Company LLC (MEA Medical Clinics)
• Evelyn Michelle Rainey, DNP, FNP-BC

• Family Nurse Practitioner in Brandon, MS
• Providers in Brandon, 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 Aug 16, 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.