Proactive MD Ms LLC – Primary Care Clinic/Center

Key facts

NPI: 1740042563
Entity type: Organization (NPI type 2)
Primary specialty: Primary Care Clinic/Center 261QP2300X
Legal business name: PROACTIVE MD MS LLC
Practice address: 6543 Ms-15
Ecru, MS 38841
Phone: (662) 489-2669
NPI assigned: Jan 26, 2024
Organization subpart: No

Authorized official

Name: Mark Allen Kemble, MD
Title: Chief Medical Officer
Phone: (864) 640-8355

Corporate family (same tax ID) 2

Organizations that report the same tax identification number in the National Provider Directory.

Proactive MD Ms LLC Primary Care Clinic/Center · Yazoo City, MS · NPI 1902474000

NPD tax ID
Proactive MD Ms LLC Primary Care Clinic/Center · Greenville, SC · NPI 1942872890

NPD tax ID

Practitioners 1

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

Amy Bridges I Family Nurse Practitioner · Ripley, MS · NPI 1013464494

NPD (past)

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
25D2300550	Ashley Wellness Center 6543 Ms-15, Ecru, MS 38841	Certificate of waiver	Mar 11, 2028

National Provider Directory

Tax ID family: Proactive MD (3 organizations share this tax ID)

Locations

6543 Highway 15 N
Ecru, MS 38841
Phone (662) 489-2669

15900 Highway 15 N
Ripley, MS 38663

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Primary Care Clinic/Center	261QP2300X			Yes

Addresses

Primary practice location

6543 Ms-15
Ecru, MS 38841

Mailing address

86 Villa Rd Ste 100
Greenville, SC 29615-3052
Phone (864) 640-8355

Other names

Ashley Wellness Center Doing business as

Other providers in Ecru, MS

All providers in Ecru, MS · Primary Care Clinic/Center in Mississippi

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 25, 2026. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.