Ortho Express Holding Company, LLC
Organization Active NPI Nurse Practitioner · Booneville, MS
NPI 1962029249 · NPPES record last updated Sep 10, 2025
Key facts
- NPI
- 1962029249
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nurse Practitioner 363L00000X
- Legal business name
- ORTHO EXPRESS HOLDING COMPANY, LLC
- Practice address
- 608 W Church St
Booneville, MS 38829 - Phone
- (662) 534-2227
- Fax
- (662) 534-2330
- NPI assigned
- Jul 2, 2020
- Organization subpart
- No
Authorized official
- Name
- Jennifer C Bullock
- Title
- President
- Phone
- (662) 534-2227
Other NPIs with the same Medicare PAC ID 7
Subparts reporting this organization as parent 3
Corporate family (same tax ID) 6
Practitioners 14
-
Cassie Allred, PA-C
-
Bradley Dillon, NP
-
Zach Glenn, NP
-
Matthew Reese Pannell, FNP-C
-
Jeffrey Pipkin, FNP
-
Tiffine Lynn Prisock, FNP-C
-
David Bradley Robbins, PA-C, ATC
-
Cameron Mitchell Wilkerson, FNP-C
-
Brandye Nicole Wilson, P.A.
-
Mark Wade Creasey, FNP-C
-
Jeffrey Eason, FNP
-
Timothy W. Pickens, FNP-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200923001417 | MS | DME Supplier - Physician - Orthopedic/Orthopedic Surgery | 1951724392 | Practice locations: Booneville, MS |
National Provider Directory
- Tax ID family
- Ortho Express Holding Company LLC
Interoperability endpoints
- zach.glenn.1@11099.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | |||
| Physician Assistant |
363A00000X | |||
| Nurse Practitioner |
363L00000X | Yes |
Addresses
Primary practice location
608 W Church St
Booneville, MS 38829
Mailing address
206 Oxford Rd
New Albany, MS 38652-3115
Phone (662) 534-2227
Other names
- OrthoXpress Bone & Joint Center of Booneville
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | zach.glenn.1@11099.direct.athenahealth.com | Direct |
Other providers in Booneville, MS
- Northeast Mississippi Inpatient Services, LLC
- Northeast Mississippi Planning and Development District
- Northeast Mississippi Planning and Development District
- Northeast Ms Internal Medicine PC
- Carly O'Neal
- Austin Brock Parris
- Karla Pellizzer
- Performance Physical Therapy, Inc.
- Felesha Dale Perrigo
- Ronald Lee Perry
All providers in Booneville, MS · Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 10, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.