Desoto Family Care Clinic, PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

901872 Issued in MS

Legal business name

DESOTO FAMILY CARE CLINIC, PLLC

Practice address

346 Stateline Rd W
Southaven, MS 38671-1610

Phone

(662) 510-5353

Fax

(662) 510-0409

NPI assigned

Aug 11, 2017

Organization subpart

No

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

Authorized official

Name

Diosan Mangubat PowellNPI 1275086902

Title

MSN

Phone

(662) 510-5353

Specialties & licenses 1

Addresses

Other names 1

• Desoto Family Care Former legal business name

Medicare fee-for-service enrollment

Enrolled in MS

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Diosan M Powell, FNP

  • Primary Care Nurse Practitioner
  • Southaven, MS
  • NPI 1275086902

  MS

  Medicare reassignment Care Compare group NPD Authorized official
• Thitiporn Sriprasert Whaley, NURSE PRACTITIONER

  • Family Nurse Practitioner
  • Southaven, MS
  • NPI 1295187789

  MS

  Medicare reassignment Care Compare group NPD
• Kerin Trinette Connor, NP

  • Nurse Practitioner
  • Southaven, MS
  • NPI 1225846991

  MS

  Medicare reassignment NPD
• Darlene Johnson

  • Family Nurse Practitioner
  • Byhalia, MS
  • NPI 1285233452

  MS, Single Specialty

  Medicare reassignment NPD
• Carlene McAllister, FNP

  • Family Nurse Practitioner
  • Collierville, TN
  • NPI 1659059798

  MS

  Medicare reassignment NPD
• Chelsea Colby Obiedzinski, FNP-C

  • Family Nurse Practitioner
  • Germantown, TN
  • NPI 1275294100

  MS

  Medicare reassignment NPD
• Tamekia Tamara Lindsay, FNP

  • Family Nurse Practitioner
  • Memphis, TN
  • NPI 1902523483
  NPD (past)

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

{
    "created_epoch": "1502409600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1678406400000",
    "number": "1972028843",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5248 GARNER LN",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386726016",
            "telephone_number": "662-510-5353",
            "fax_number": "662-510-0409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "346 STATELINE RD W",
            "city": "SOUTHAVEN",
            "state": "MS",
            "postal_code": "386711610",
            "telephone_number": "662-510-5353",
            "fax_number": "662-510-0409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DESOTO FAMILY CARE CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-11",
        "last_updated": "2023-03-10",
        "certification_date": "2023-03-10",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "DIOSAN",
        "authorized_official_middle_name": "MANGUBAT",
        "authorized_official_title_or_position": "MSN",
        "authorized_official_telephone_number": "662-510-5353"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "901872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Desoto Family Care",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Desoto Family Care",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Desoto County School
• Desoto Dna and Diagnostic Center
• Desoto Eye and Ear
• Desoto Eye Surgery Center LLC
• Desoto Eyecare Inc
• Desoto Family Counseling Center PLLC
• Desoto Family Counseling Center, PLLC
• Desoto Family Medical Center
• Desoto Family Vision PLLC
• Desoto Family Wellness Center, LLC

• Family Medicine Physician in Southaven, MS
• Providers in Southaven, MS by specialty
• Family Medicine Physician in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.