1780652362 NPI number — JODY T ADAMS CFNP

Table of content: JODY T ADAMS CFNP (NPI 1780652362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780652362 NPI number — JODY T ADAMS CFNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ADAMS
Provider First Name:
JODY
Provider Middle Name:
T
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CFNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780652362
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
587 HIGHWAY 51 STE T
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIDGELAND
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39157-2567
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-790-7711
Provider Business Mailing Address Fax Number:
601-790-7712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
728 CLINTON PKWY
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39056-5227
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-200-4800
Provider Business Practice Location Address Fax Number:
601-924-0473
Provider Enumeration Date:
03/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  R688797 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 753068151001 . This is a "TRICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 00124952 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 753068151 . This is a "MS HEALTH PARTNERS" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 753068151 . This is a "MS PHYSICIANS CARE NETWOR" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: 168390703 . This is a "US DEPT OF LABOR" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".
  • Identifier: P00062082 . This is a "RR MEDICARE" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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