Walton Family Care Clinic, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R871879 Issued in MS

Legal business name

WALTON FAMILY CARE CLINIC, LLC

Practice address

228 Starlyn Ave
New Albany, MS 38652-2428

Phone

(662) 539-7383

Fax

(662) 539-7661

NPI assigned

Oct 11, 2016

Organization subpart

No

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

Authorized official

Name

Dr. Tyrongilia Q Walton, DNP

Title

Owner

Phone

(662) 539-7383

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1476144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486425600000",
    "number": "1710437074",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 611",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386520611",
            "telephone_number": "662-539-7383",
            "fax_number": "662-539-7661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "228 STARLYN AVE",
            "city": "NEW ALBANY",
            "state": "MS",
            "postal_code": "386522428",
            "telephone_number": "662-539-7383",
            "fax_number": "662-539-7661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WALTON FAMILY CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-10-11",
        "last_updated": "2017-02-07",
        "status": "A",
        "authorized_official_last_name": "WALTON",
        "authorized_official_first_name": "TYRONGILIA",
        "authorized_official_middle_name": "Q",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-539-7383",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R871879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "07630093",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE NUMBER",
            "identifier": "272046ZWX3",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Nurse Practitioner in New Albany, MS
• Providers in New Albany, 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 Feb 7, 2017; 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.