AGELESS MEN'S HEALTH, LLC (NPI# 1124322474) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1124322474 |
| Entity Type | Organization |
| Organization Name | AGELESS MEN'S HEALTH, LLC |
| Practice Address |
7111 Southcrest Pkwy Suite 109 Southaven MS 38671-4850 |
| Practice Telephone | 9015226745 |
| Practice Fax Number | 9015226748 |
| Mailing Telephone | 9015226745 |
| Mailing Fax Number | 9015226748 |
| Enumeration Date | 2010-12-30 |
| Last Update Date | 2010-12-30 |
| Authorized Official Name | MRS. MELISSA C MCCLELLAN (REGIONAL BUSINESS MANAGER) |
| Authorized Official Telephone | 9015226745 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
Physician Assistants & Advanced Practice Nursing Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023427259 | Ageless Men's Health, LLC | Specialist | 6915 Crumpler Blvd, Suite C, Olive Branch, MS 38654-1965 | 2014-08-13 |
| 1841639648 | Ageless Men's Health, LLC | Specialist | 1022 Common Wealth Blvd, Tupelo, MS 38801 | 2013-06-14 |
| 1003098997 | Ageless Men's Health, LLC | Clinical Medical Laboratory | 530 Oak Court Dr, Suite 125, Memphis, TN 38117-3726 | 2007-12-03 |
| Street Address |
7111 SOUTHCREST PKWY SUITE 109 |
| City | SOUTHAVEN |
| State | MS |
| Zip Code | 38671-4850 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285196196 | Emma Tinsley-bowles Long | Social Worker | 8786 Northcreek Blvd, Bldg 8 Apt 3, Southaven, MS 38671 | 2019-04-01 |
| 1851847586 | Tiffany Lashea Jones | Adult Companion | 8755 Millbranch Road, Southaven, MS 38671 | 2016-09-01 |
| 1538526140 | Desoto Pediatric Extended Care LLC | Skilled Nursing Facility | 750 Stateline Road East, Southhaven, MS 38671 | 2016-01-27 |
| 1073983052 | Tara Burt | Physical Therapist | 7900 Airways Blvd. Building A, Suite 2, Southaven, MS 38671 | 2015-10-02 |
| 1295160463 | Ideal Community Care,llc | In Home Supportive Care | 8869 Centre Str #3, Southaven, MS 38671 | 2013-09-06 |
| 1578995692 | Gregory Charles Eakins Jr. | Optometrist | 338 Goodman Rd West, Southaven, MS 38671 | 2013-07-31 |
| 1295173169 | Erica R. Martin | Social Worker | 975 Swinnea Rdg Ste 3, Southaven, MS 38671 | 2013-06-12 |
| 1386918431 | Freds Stores of Tennessee Inc | Pharmacy | 710 Church Road, Southaven, MS 38671 | 2012-03-06 |
| 1740565613 | Mary Jeanette Scruggs | Pharmacist | 1011 Goodman Rd, Southaven, MS 38671 | 2011-10-11 |
| 1184919268 | First Pharmacy Services 5 | Pharmacy | 5185a Getwell Rd, Southaven, MS 38671 | 2011-06-16 |
| Find all providers in zip 38671 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922615616 | Jack Chandler Papa | Nurse Practitioner | 3556 May Brook Cv, Southaven, MS 38672-1006 | 2020-09-26 |
| 1518583129 | Susan E Mccullough | Nurse Practitioner | 5932 Antler Trl, Southaven, MS 38672-6511 | 2020-06-19 |
| 1336764778 | Raquel Janay Reed-washington | Nurse Practitioner | 3548 Herbert Cv, Southaven, MS 38672-2003 | 2020-06-11 |
| 1104452887 | Vincent Lee Spinosa-parker | Nurse Practitioner | 5056 Maiden Lane Cv, Southaven, MS 38672-6000 | 2020-03-13 |
| 1215438437 | Alba Laura Emerson | Nurse Practitioner | 1862 Lindsey Ln, Southaven, MS 38672-8602 | 2018-02-22 |
| 1629583026 | Lachasity Kimmons | Nurse Practitioner | 2032 Audubon Pl, Southaven, MS 38672-9440 | 2017-12-06 |
| 1487757365 | Regina G Seaton | Nurse Practitioner | 7676 Airways Blvd, Southaven, MS 38671-5304 | 2006-09-06 |
| 1063465482 | Misty Ann Moore | Nurse Practitioner | 7585 Clarington Cove, Southaven, MS 38671-2300 | 2006-05-18 |
| 1184602450 | Tammy Louise Carnahan | Nurse Practitioner | 7900 Airways Blvd, Building A Suite 6, Southaven, MS 38671-4113 | 2006-01-05 |
| 1831728583 | Treneise Hunt-smith | Nurse Practitioner | 340 Stateline Rd W, Southaven, MS 38671-1610 | 2020-04-05 |
| Find all providers in SOUTHAVEN | ||||
Please comment or provide details below to improve the information on AGELESS MEN'S HEALTH, LLC.
| 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.