NPIMap

Organization Active NPI

Flowood Family Medicine, PLLC

  • Family Medicine Physician
  • Flowood, MS
National Provider Identifier
1891972022
Registry record updated Aug 20, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
19643 Issued in MS
Legal business name
FLOWOOD FAMILY MEDICINE, PLLC
Practice address
1 Layfair Dr
Suite 100
Flowood, MS 39232-9717
Phone
(601) 939-4008
Fax
(601) 939-4010
NPI assigned
Jan 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 20, 2009

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

Authorized official

Name
Dr. Kevin M Young, M.D.
Title
Owner
Phone
(601) 939-4008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207Q00000X 19643 MS Primary

Addresses

Primary practice location

1 Layfair Dr
Suite 100
Flowood, MS 39232-9717

Mailing address

1 Layfair Dr
Suite 100
Flowood, MS 39232-9717
Phone (601) 939-4008

Other identifiers 2

IdentifierTypeStateIssuer
DO4168OtherMEDICARE RR
03136371MedicaidMS

Other names 1

  • Medical Wellness and Nutrition Center of MS Doing business as

National Provider Directory

National Provider Directory

Locations

1 Layfair Dr
Ste 100
Jackson, MS 39232
Phone (601) 936-8800

NPI Registry JSON

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

{
    "created_epoch": "1201651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1250726400000",
    "number": "1891972022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 LAYFAIR DR",
            "address_2": "SUITE 100",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329717",
            "telephone_number": "601-939-4008",
            "fax_number": "601-939-4010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 LAYFAIR DR",
            "address_2": "SUITE 100",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392329717",
            "telephone_number": "601-939-4008",
            "fax_number": "601-939-4010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLOWOOD FAMILY MEDICINE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-30",
        "last_updated": "2009-08-20",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-939-4008",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "19643",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RR",
            "identifier": "DO4168",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03136371",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Medical Wellness and Nutrition Center of MS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Flowood, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2009; 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.