UPA PLLC ADOLESCENT MED (NPI# 1205953809) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205953809 |
| Entity Type | Organization |
| Organization Name | UPA PLLC ADOLESCENT MED |
| Practice Address |
2500 N State St Jackson MS 39216-4500 |
| Practice Telephone | 6019845236 |
| Mailing Telephone | 6019845236 |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2008-06-24 |
| Authorized Official Name | OWEN B EVANS (MANAGING EMPLOYEE) |
| Authorized Official Telephone | 6019845214 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2080A0000X |
Pediatrics Specialization: Adolescent Medicine |
Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 09015331 | 05 |
| Street Address |
2500 N STATE ST |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4500 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477556231 | University Ophthalmology Associates | Ophthalmology | 2500 N State St, Ste B329, Jackson, MS 39216-4500 | 2005-05-24 |
| 1396346607 | Ashleigh Renfroe Hannah | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2020-11-03 |
| 1770182438 | Tara P. Carter | Nurse Practitioner | 2500 N State St, Jackson, MS 39216-4500 | 2020-10-22 |
| 1679189849 | Raegan Wilson | Registered Nurse | 2500 N State St, Jackson, MS 39216-4500 | 2020-09-22 |
| 1851905095 | Violet Maloba Awori | Student in an Organized Health Care Education/Training Program | 2500 N State St, Jackson, MS 39216-4500 | 2020-09-04 |
| 1295348639 | Kassidy Voinche | Pharmacist | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-25 |
| 1215549423 | Brittney Leeann Williams | Pharmacist | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-19 |
| 1912519364 | Rashmi Verma | Internal Medicine | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-18 |
| 1982215414 | Anita Dhanrajani | Pediatrics | 2500 N State St, Jackson, MS 39216-4500 | 2020-08-10 |
| 1528676954 | Nicholas Mcafee | Psychologist | 2500 N State St, Jackson, MS 39216-4500 | 2020-07-22 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 2080A0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Adolescent Medicine |
| A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. American Osteopathic Board of Pediatrics, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659366854 | Michelle J Gibson | Pediatrics | 5440 Watkins Dr, Suite B, Jackson, MS 39206-2034 | 2005-09-13 |
| 1295908101 | Dr. Mendoza's Pediatric and Adolscent | Pediatrics | 424 Jett Dr, Jackson, KY 41339-9621 | 2008-04-11 |
| 1871566323 | David J Stone | Pediatrics | 100 Mission Blvd, Suite 2600, Jackson, CA 95642-2536 | 2006-02-07 |
| 1548259559 | Radha Inagandla Alur | Pediatrics | 2500 N State St, Jackson, MS 39216 | 2005-10-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144632662 | Touching Hands Healing Hearts Pllc | Pediatrics | 108 Bay Harbour Pl, Brandon, MS 39047-6108 | 2014-06-02 |
| 1447507009 | S.ali A Naqvi | Pediatrics | 234 S 12th Ave, Laurel, MS 39440-4325 | 2012-08-13 |
| 1477745511 | Susan P Parks | Pediatrics | 222 Rankin Rd, Canton, MS 39046-4874 | 2007-08-13 |
| 1033210315 | Natchez Pediatric Clinic Pllc | Pediatrics | 136 Jefferson Davis Blvd., Suite A, Natchez, MS 39120 | 2006-09-26 |
| 1487677340 | Chiazo Nnawuchi-ekenna | Pediatrics | 4505 Hospital St, Ste C, Pascagoula, MS 39581-3609 | 2006-07-25 |
| 1518911445 | Achyutha S Pujari | Pediatrics | 1203 Ave B, Ste 200, Ellisville, MS 39437-2080 | 2006-05-22 |
| 1881167435 | Sara Kain | Pediatrics | 2888 S Lamar Blvd, Oxford, MS 38655-5347 | 2019-01-07 |
| 1194111666 | Grant Patrick Saxton | Pediatrics | 1002 Jefferson Street, Suite 200, Laurel, MS 39440-4306 | 2015-04-11 |
| 1821342379 | South Central Regional Medical Center | Pediatrics | 234 S 12th Ave, Laurel, MS 39440-4325 | 2012-11-06 |
| 1144418609 | Lafayette Pediatric Clinic | Pediatrics | 2166 S Lamar Blvd, Oxford, MS 38655-5224 | 2007-10-10 |
| Find all providers with the same taxonomy | ||||
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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.