Gautier Family Clinic, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

GAUTIER FAMILY CLINIC, LLC

Practice address

4533B Gautier Vancleave Rd
Gautier, MS 39553

Phone

(228) 202-5924

Fax

(228) 202-5918

NPI assigned

Oct 8, 2021

Organization subpart

No

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

Authorized official

Name

Laura R. Boleware, FNP

Title

Owner

Phone

(601) 800-8580

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1942962816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "MARCIA EASTERWOOD",
            "address_2": "P.O. BOX 177",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "39437",
            "telephone_number": "601-800-8580",
            "fax_number": "601-800-8583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4533B GAUTIER VANCLEAVE RD",
            "city": "GAUTIER",
            "state": "MS",
            "postal_code": "39553",
            "telephone_number": "228-202-5924",
            "fax_number": "228-202-5918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GAUTIER FAMILY CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-08",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "BOLEWARE",
        "authorized_official_first_name": "LAURA",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-800-8580",
        "authorized_official_credential": "FNP"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Courtney Jerthel Gibbs

• Nurse Practitioner in Gautier, MS
• Providers in Gautier, MS by specialty
• Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; 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.