NPIMap

Organization Active NPI

Faith Family Clinic, LLC

  • Primary Care Clinic/Center
  • Booneville, MS
National Provider Identifier
1831288281
Registry record updated Oct 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
Legal business name
FAITH FAMILY CLINIC, LLC
Practice address
2209 N 2ND St
Booneville, MS 38829-7734
Phone
(662) 728-0162
NPI assigned
Oct 12, 2006
Last updated
Oct 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2011

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

Authorized official

Name
Mrs. Kelly Bernice Thornton, APRN, BC
Title
Family Nurse Practitioner/Co-Owner
Phone
(662) 415-0270

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X NU Primary

Addresses

Primary practice location

2209 N 2ND St
Booneville, MS 38829-7734

Mailing address

2209 N 2ND St
Booneville, MS 38829-7734
Phone (662) 728-0162

National Provider Directory

National Provider Directory

Locations

2209 N 2nd St
Booneville, MS 38829
Phone (662) 728-0162

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318550400000",
    "number": "1831288281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2209 N 2ND ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388297734",
            "telephone_number": "662-728-0162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2209 N 2ND ST",
            "city": "BOONEVILLE",
            "state": "MS",
            "postal_code": "388297734",
            "telephone_number": "662-728-0162"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAITH FAMILY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-12",
        "last_updated": "2011-10-14",
        "status": "A",
        "authorized_official_last_name": "THORNTON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "BERNICE",
        "authorized_official_title_or_position": "FAMILY NURSE PRACTITIONER/CO-OWNER",
        "authorized_official_telephone_number": "662-415-0270",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "APRN, BC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Booneville, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2011; 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.