Prolific Health & Wellness PA

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

PROLIFIC HEALTH & WELLNESS PA

Practice address

2675 River Ridge Dr
Jackson, MS 39216-5012

Phone

(769) 257-0586

NPI assigned

Oct 23, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Kimberly McCullough Smash, MD

Title

Founder

Phone

(769) 257-0586

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1508716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1514937600000",
    "number": "1962913541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "605 CHICKASAW DR N",
            "city": "FLOWOOD",
            "state": "MS",
            "postal_code": "392328680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2675 RIVER RIDGE DR",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165012",
            "telephone_number": "769-257-0586"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROLIFIC HEALTH & WELLNESS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-23",
        "last_updated": "2018-01-03",
        "status": "A",
        "authorized_official_last_name": "SMASH",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "MCCULLOUGH",
        "authorized_official_title_or_position": "FOUNDER",
        "authorized_official_telephone_number": "769-257-0586",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Jackson, MS
• Providers in Jackson, MS by specialty
• Clinic/Center in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2018; 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.