Active NPI
Irene Martin, CFNP
- Nurse Practitioner
- McComb, MS
National Provider Identifier
1790905941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- R736598
- Practice address
- 120 5TH Avenue
McComb, MS 39648 - Phone
- (601) 249-0013
- Fax
- (601) 249-0592
- NPI assigned
- Apr 30, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | R736598 | MS | Primary |
Addresses
Primary practice location
120 5TH Avenue
McComb, MS 39648
Mailing address
1014 Causey Road
McComb, MS 39648
Phone (601) 876-4926
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0111641 | Medicaid | MS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1341532800000",
"number": "1790905941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1014 CAUSEY ROAD",
"city": "MCCOMB",
"state": "MS",
"postal_code": "39648",
"telephone_number": "601-876-4926",
"fax_number": "601-876-0980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "120 5TH AVENUE",
"city": "MCCOMB",
"state": "MS",
"postal_code": "39648",
"telephone_number": "601-249-0013",
"fax_number": "601-249-0592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARTIN",
"first_name": "IRENE",
"credential": "CFNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-04-30",
"last_updated": "2012-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "MS",
"license": "R736598",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0111641",
"state": "MS"
}
],
"endpoints": [],
"other_names": []
}Other providers in McComb, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.