Marietta Family Clinic, Inc.

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R853095 Issued in MS

Legal business name

MARIETTA FAMILY CLINIC, INC.

Practice address

3 CR 4050
Marietta, MS 38856

Phone

(662) 728-2408

Fax

(662) 728-2409

NPI assigned

Jul 10, 2006

Organization subpart

No

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

Authorized official

Name

Lori Harris, CFNPNPI 1811168578

Title

Owner

Phone

(662) 728-2408

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

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

• Lori Cleo Harris, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Marietta, MS
  • NPI 1811168578
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753660800000",
    "number": "1922032812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 56",
            "city": "MARIETTA",
            "state": "MS",
            "postal_code": "388560056",
            "telephone_number": "662-728-2408",
            "fax_number": "662-728-2409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3 CR 4050",
            "city": "MARIETTA",
            "state": "MS",
            "postal_code": "38856",
            "telephone_number": "662-728-2408",
            "fax_number": "662-728-2409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIETTA FAMILY CLINIC, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2025-07-28",
        "certification_date": "2025-07-28",
        "status": "A",
        "authorized_official_last_name": "HARRIS",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "662-728-2408",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R853095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03282808",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lori Cleo Harris, NURSE PRACTITIONER
• Kristi M Slack, CF NP

• Family Nurse Practitioner in Marietta, MS
• Providers in Marietta, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.