Kimberlie La'Tasha Mabry, FNP-C

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

905478 Issued in MS

Practice address

1509 Willowbend Dr
Gautier, MS 39553-7627

Phone

(228) 627-1223

NPI assigned

Aug 1, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Calcasieu Urgent Care LLCGroup PAC ID 5496908071, 132 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Calcasieu Urgent Care LLC

  • Urgent Care Clinic/Center
  • Lake Charles, LA
  • NPI 1467715490
  Medicare reassignment Care Compare group NPD
• Signify Health, LLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1689158487

  LA, Nurse Practitioner

  Medicare reassignment NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Hoover, AL
  • NPI 1538686498

  Family Medicine, LA

  Medicare reassignment NPD
• Avid Health Services LLC

  • Family Nurse Practitioner
  • Houma, LA
  • NPI 1629912936
  NPD Authorized official
• Calcasieu Urgent Care, LLC

  • Rural Health Clinic/Center
  • Breaux Bridge, LA
  • NPI 1194482398
  NPD
• Upperline Healthcare, PC

  • Foot & Ankle Surgery Podiatrist
  • Ocoee, FL
  • NPI 1326906843
  NPD

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

{
    "created_epoch": "1659312000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689638400000",
    "number": "1891422853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1509 WILLOWBEND DR",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395537627",
            "telephone_number": "228-627-1223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1509 WILLOWBEND DR",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "395537627",
            "telephone_number": "228-627-1223"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MABRY",
        "first_name": "KIMBERLIE",
        "middle_name": "LA'TASHA",
        "name_prefix": "Mrs.",
        "credential": "FNP-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-01",
        "last_updated": "2023-07-18",
        "certification_date": "2023-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MS",
            "license": "905478",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "LA",
            "license": "227359",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "905478",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Loving Hearts Homecare Services LLC
• Monique Raenette Lowe, BS
• Jessica Lee Luce, CRNA
• Leslie Eaton Lyons
• Channon Rebecca Lytton, E.DD.
• Ebbie Larhonda Maddox, LMSW
• Magnolia Occupational & Physical Therapy, LLC
• Loggan Malone Weihe, DMD
• Ellen L.H. Malone, LISW, LCSW, ACSW
• Amber Nicole Mapp, BA

• Family Medicine Physician in Gautier, MS
• Providers in Gautier, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (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.