NPIMap

Organization Active NPI

Advanced Medical Rehabilitation, LLC

  • Family Nurse Practitioner
  • Clarksdale, MS
National Provider Identifier
1831132562
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R659975 Issued in MS
Legal business name
ADVANCED MEDICAL REHABILITATION, LLC
Practice address
1051 Lee Dr
Suite 1B
Clarksdale, MS 38614-3615
Phone
(662) 624-2466
Fax
(662) 624-4876
NPI assigned
Jun 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. John C. Berry
Title
Owner
Phone
(662) 624-2466

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X R659975 MS Primary

Addresses

Primary practice location

1051 Lee Dr
Suite 1B
Clarksdale, MS 38614-3615

Mailing address

1051 Lee Drive
Suite 1B
Clarksdale, MS 38614-3616
Phone (662) 624-2466

National Provider Directory

National Provider Directory

Locations

1015 Lee Dr
#1B
Clarksdale, MS 38614
Phone (662) 624-2466

1051 Lee Dr
Ste 1B
Clarksdale, MS 38614
Phone (662) 624-2466

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1150156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1831132562",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1051 LEE DRIVE",
            "address_2": "SUITE 1B",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386143616",
            "telephone_number": "662-624-2466",
            "fax_number": "662-624-4876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1051 LEE DR",
            "address_2": "SUITE 1B",
            "city": "CLARKSDALE",
            "state": "MS",
            "postal_code": "386143615",
            "telephone_number": "662-624-2466",
            "fax_number": "662-624-4876"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADVANCED MEDICAL REHABILITATION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BERRY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-624-2466",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R659975",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clarksdale, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.