Jerry Deane Tankersley, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

2300-86 Issued in MS

Practice address

800 Ohio Ave
Clarksdale, MS 38614-7200

Phone

(662) 624-4292

Fax

(662) 627-3629

NPI assigned

May 14, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• North Sunflower Medical Center

  • Family Medicine Physician
  • Cleveland, MS
  • NPI 1891705133
  Medicare reassignment NPD
• North Sunflower Medical Center

  • Hospitalist Physician
  • Ruleville, MS
  • NPI 1013128644
  NPD
• North Sunflower Medical Center

  • Durable Medical Equipment & Medical Supplies
  • Greenwood, MS
  • NPI 1730903287
  NPD

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

{
    "created_epoch": "1242259200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1246320000000",
    "number": "1710111034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 HIGHWAY 322",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386144717",
            "telephone_number": "662-624-2504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 OHIO AVE",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386147200",
            "telephone_number": "662-624-4292",
            "fax_number": "662-627-3629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TANKERSLEY",
        "first_name": "JERRY",
        "middle_name": "DEANE",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-14",
        "last_updated": "2009-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MS",
            "license": "2300-86",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tiffany Smith Stewart, M.ED.
• Shatoyia Monique Stovall, LCSW, LICSW, LSCSW
• Strivus Inc
• Mtanius A Sultani, MD
• Stanley Mark Swentkowski, M.C.D., CCC-SLP
• Jackie Tanna, MA
• Tammy T Taylor-Bufford, FNP
• Amquita Taylor, MD.E
• Evelyn Taylor, M.ED.
• Joan H Tedford, P.T.

• Dentist in Clarksdale, MS
• Providers in Clarksdale, MS by specialty
• Dentist in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.