JESSICA ANNE LAUDERDALE (NPI# 1093095523) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1093095523 |
| Entity Type | Individual |
| Full Name | JESSICA ANNE LAUDERDALE |
| Credential | DO |
| Practice Address |
1665 S Green St Tupelo MS 38804-6556 |
| Practice Telephone | 6623772189 |
| Mailing Telephone | 6623772189 |
| Enumeration Date | 2011-08-29 |
| Last Update Date | 2015-06-15 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 23832 | MS | Allopathic & Osteopathic Physicians |
| N | 208D00000X | General Practice | L2069591 | MI | Allopathic & Osteopathic Physicians |
| Street Address |
1665 S GREEN ST |
| City | TUPELO |
| State | MS |
| Zip Code | 38804-6556 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497748941 | James Lauvon Taylor IIi | Pharmacist | 1665 S Green St, Tupelo, MS 38804-6556 | 2005-08-30 |
| 1427673532 | Garrett Fratesi | Student in an Organized Health Care Education/Training Program | 1665 S Green St, Tupelo, MS 38804-6556 | 2020-06-15 |
| 1629692769 | Jeremy Keon Prince | Family Medicine | 1665 S Green St, Tupelo, MS 38804-6556 | 2020-06-04 |
| 1598389702 | Ethan Collier | Student in an Organized Health Care Education/Training Program | 1665 S Green St, Tupelo, MS 38804-6556 | 2020-06-03 |
| 1104440544 | Ridgeland Clay Dabbs | Student in an Organized Health Care Education/Training Program | 1665 S Green St, Tupelo, MS 38804-6556 | 2020-06-02 |
| 1366066698 | Raaj Ghosal | Student in an Organized Health Care Education/Training Program | 1665 S Green St, Tupelo, MS 38804-6556 | 2020-06-02 |
| 1720602295 | Nathaniel Thomas Sparks | Student in an Organized Health Care Education/Training Program | 1665 S Green St, Tupelo, MS 38804-6556 | 2020-06-01 |
| 1730703158 | Joseph Brooks Pratt | Student in an Organized Health Care Education/Training Program | 1665 S Green St, Tupelo, MS 38804-6556 | 2020-06-01 |
| 1053971606 | Marcus John Wilson | Student in an Organized Health Care Education/Training Program | 1665 S Green St, Tupelo, MS 38804-6556 | 2019-06-17 |
| 1952961500 | Nicholas William Bondio | Student in an Organized Health Care Education/Training Program | 1665 S Green St, Tupelo, MS 38804-6556 | 2019-06-17 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548874159 | Susan Me'chelle Oliver | Nurse Practitioner | 874 Barnes Crossing Road, Tupelo, MS 38804 | 2020-09-01 |
| 1134762784 | Kimberly J Adams | Occupational Therapy Assistant | 90 Clark Ave, Tupelo, MS 38804 | 2019-10-25 |
| 1790270924 | Megan Guntharp | Occupational Therapist | 960 Commonwealth Boulevard, Tupelo, MS 38804 | 2018-06-29 |
| 1154867562 | Urologic Ambulatory Surgery Center, LLC | Clinic/Center | 3353 N Gloster Street, Suite 300, Tupelo, MS 38804 | 2017-01-09 |
| 1790235919 | Dr Scott Dickinson D.m. D. PC | Dentist | 3999 N Gloster Street, Tupelo, MS 38804 | 2016-10-12 |
| 1326496621 | Angela Estes | Occupational Therapist | County Road 1279 House#197, Tupelo, MS 38804 | 2016-05-26 |
| 1316300080 | Eric Wade Tillotson | Family Medicine | 1665 South Green Street, Tupelo, MS 38804 | 2016-03-31 |
| 1104238898 | Stella M. Johnson | Social Worker | 2292 Camelot Cir, Tupelo, MS 38804 | 2014-05-29 |
| 1821437351 | Lenka Petersen | Student in an Organized Health Care Education/Training Program | 1665 S Green St., Nmmc, Tupelo, MS 38804 | 2013-06-18 |
| 1083966303 | Jessica M Baskett | Counselor | 398 E Main St, Tupelo, MS 38804 | 2012-10-10 |
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| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316300080 | Eric Wade Tillotson | Family Medicine | 1665 South Green Street, Tupelo, MS 38804 | 2016-03-31 |
| 1770968919 | Ouch Urgent Care Inc | Family Medicine | 1710 N Gloster St, Tupelo, MS 38804-1216 | 2015-07-29 |
| 1003166745 | North Mississippi Medical Clinics, Inc. | Family Medicine | 1040a S. Madison St, Tupelo, MS 38801-6300 | 2012-09-10 |
| 1073879029 | North Mississippi Medical Clinics, Inc. | Family Medicine | 1680 S Green St, Tupelo, MS 38804-6543 | 2012-04-04 |
| 1992935266 | William T Jennings | Family Medicine | 826 Clayton Ave, Tupelo, MS 38804-1918 | 2009-07-21 |
| 1003059874 | Aaron Ashley Amos | Family Medicine | 1020 N Gloster St # 123, Tupelo, MS 38804-1202 | 2009-04-09 |
| 1083898803 | Raines Atherton Chaffin | Family Medicine | 125 County Road 1698, Tupelo, MS 33804 | 2007-12-28 |
| 1164629747 | North Mississippi Medical Clinics Inc | Family Medicine | 844 S Madison St Ste B, Tupelo, MS 38801-4904 | 2007-06-28 |
| 1295816072 | William M. Hilbun Jr. | Family Medicine | 874 Barnes Crossing Rd, Suite A, Tupelo, MS 38804-0909 | 2006-10-18 |
| 1659399723 | Phillip Edward Jones | Family Medicine | 1200 N Gloster St, Tupelo, MS 38804-1206 | 2006-07-17 |
| Find all providers in TUPELO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.