Aa Primary Care Services, LLC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

R852821 Issued in MS

Legal business name

AA PRIMARY CARE SERVICES, LLC

Practice address

134 Jervis Mims Rd
Hattiesburg, MS 39401-8864

Phone

(601) 255-5705

NPI assigned

May 17, 2012

Last updated

Sep 8, 2015By 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

Lisa Parker, FNP-BC

Title

Owner

Phone

(601) 554-6959

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1337212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1441670400000",
    "number": "1962762401",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "134 JERVIS MIMS RD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "134 JERVIS MIMS RD",
            "city": "HATTIESBURG",
            "state": "MS",
            "postal_code": "394018864",
            "telephone_number": "601-255-5705"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AA PRIMARY CARE SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-17",
        "last_updated": "2015-09-08",
        "status": "A",
        "authorized_official_last_name": "PARKER",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "601-554-6959",
        "authorized_official_credential": "FNP-BC"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "R852821",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08657850",
            "state": "MS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12027545",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2015; 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.