Kids' Kastle Gluckstadt

Primary specialty

Pediatric Skilled Nursing FacilityTaxonomy code 3140N1450X

Legal business name

KIDS' KASTLE GLUCKSTADT

Practice address

112 Westfalen Drive
Canton, MS 39046

Phone

(601) 499-0167

Fax

(601) 499-0294

NPI assigned

Dec 26, 2019

Last updated

Dec 26, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mrs. Jetuwan M BrownNPI 1104176049

Title

Managing Officer

Phone

(601) 278-6710

Specialties & licenses 2

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jetuwan M Brown, REGISTERED NURSE

  • Registered Nurse
  • Canton, MS
  • NPI 1104176049
  NPD Authorized official

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

{
    "created_epoch": "1577318400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577318400000",
    "number": "1962041798",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 AULENBROCK DR STE A",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "390467036",
            "telephone_number": "601-499-0167",
            "fax_number": "601-499-0294"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "112 WESTFALEN DRIVE",
            "city": "CANTON",
            "state": "MS",
            "postal_code": "39046",
            "telephone_number": "601-499-0167",
            "fax_number": "601-499-0294"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDS' KASTLE GLUCKSTADT",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-26",
        "last_updated": "2019-12-26",
        "certification_date": "2019-12-26",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "JETUWAN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MANAGING OFFICER",
        "authorized_official_telephone_number": "601-278-6710",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "251J00000X",
            "taxonomy_group": "",
            "desc": "Nursing Care",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "3140N1450X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility, Nursing Care, Pediatric",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deneitra Jones, CNA AN LPN
• Michael K Jones, DC
• Joseph W Gunter III MD PLLC
• David L Kaiser, DPM
• Kristina Keiser, PT, DPT
• Eric Falandia Kiner
• Elizabeth W Knotts, SLP
• Annaleigh C Kurr, PT
• L.C. Tennin, Jr M.D., P.a.
• Lampkin and Nelson Family Dentistry PA

• Pediatric Skilled Nursing Facility in Canton, MS
• Providers in Canton, MS by specialty
• Pediatric Skilled Nursing Facility in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2019; 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.