Puckett Medical Clinic

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

License

R633283 Issued in MS

Legal business name

PUCKETT MEDICAL CLINIC

Practice address

6455 Highway 18
Brandon, MS 39042-7536

Phone

(601) 824-9490

Fax

(601) 824-9533

NPI assigned

Nov 30, 2011

Organization subpart

No

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

Authorized official

Name

Debra Develin, CFNP

Title

Owner

Phone

(601) 824-9490

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1322611200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322611200000",
    "number": "1932476280",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 366",
            "city": "PUCKETT",
            "state": "MS",
            "postal_code": "391510366",
            "telephone_number": "601-824-9490",
            "fax_number": "691-824-9533"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6455 HIGHWAY 18",
            "city": "BRANDON",
            "state": "MS",
            "postal_code": "390427536",
            "telephone_number": "601-824-9490",
            "fax_number": "601-824-9533"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PUCKETT MEDICAL CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-30",
        "last_updated": "2011-11-30",
        "status": "A",
        "authorized_official_last_name": "DEVELIN",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-824-9490",
        "authorized_official_credential": "CFNP"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": "MS",
            "license": "R633283",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Health Service Clinic/Center in Brandon, MS
• Providers in Brandon, MS by specialty
• Health Service Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 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.