NPIMap

Organization Active NPI

Cradle to the Grave Healthcare LLC

  • Nurse Practitioner
  • Leakesville, MS
National Provider Identifier
1770935611
Registry record updated Jul 3, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
R875627 Issued in MS
Legal business name
CRADLE TO THE GRAVE HEALTHCARE LLC
Practice address
413 Saint Francis St Ste B
Leakesville, MS 39451-8909
Phone
(251) 645-4539
Fax
(601) 947-1331
NPI assigned
Jul 3, 2016
Last updated
Jul 3, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2016

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

Authorized official

Name
Susan Rutledge
Title
Director
Phone
(601) 947-1330

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363L00000X R875627 MS Primary

Addresses

Primary practice location

413 Saint Francis St Ste B
Leakesville, MS 39451-8909

Mailing address

PO Box 1126
Leakesville, MS 39451-1126
Phone (601) 947-1330

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1467504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1467504000000",
    "number": "1770935611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1126",
            "city": "LEAKESVILLE",
            "state": "MS",
            "postal_code": "394511126",
            "telephone_number": "601-947-1330",
            "fax_number": "601-947-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 SAINT FRANCIS ST STE B",
            "city": "LEAKESVILLE",
            "state": "MS",
            "postal_code": "394518909",
            "telephone_number": "251-645-4539",
            "fax_number": "601-947-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRADLE TO THE GRAVE HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-03",
        "last_updated": "2016-07-03",
        "status": "A",
        "authorized_official_last_name": "RUTLEDGE",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "601-947-1330"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "R875627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Leakesville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2016; 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.