DR. KENTRELL MARIE LIDDELL (NPI# 1659384063) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659384063 |
| Entity Type | Individual |
| Full Name | DR. KENTRELL MARIE LIDDELL |
| Credential | M.D. |
| Practice Address |
2104 Thousand Oaks Dr Jackson MS 39212-2048 |
| Practice Telephone | 6013467450 |
| Practice Fax Number | 6013467451 |
| Mailing Telephone | 6013467450 |
| Mailing Fax Number | 6013467451 |
| Enumeration Date | 2006-08-15 |
| Last Update Date | 2013-04-09 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 17997 | MS | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 08072071 | 05 | |
| MS | UNITED HEALTHCARE | 11859914 | 01 |
| Street Address |
2104 THOUSAND OAKS DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39212-2048 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013406172 | South Central Community Action Agency, Inc | Non-emergency Medical Transport (VAN) | 3891 I-55 South Frontage Rd, Jackson, MS 39212 | 2018-05-04 |
| 1508305780 | Caring Companions LLC | Home Health | 1024 Cooper Rd, Jackson, MS 39212 | 2017-02-21 |
| 1750634044 | Christians In Action, Inc. | Community/Behavioral Health | 2025 North Siwell Rd, Jackson, MS 39212 | 2012-10-24 |
| 1609164748 | Counseling and Mentoring Program | Community/Behavioral Health | 2964 Terry Road B-1, Jackson, MS 39212 | 2011-07-11 |
| 1407179039 | Caring Hands Community Services Inc | Skilled Nursing Facility | 3318 Longwood Drive, Jackson, MS 39212 | 2010-03-10 |
| 1992239404 | Shaemik Harris | Registered Nurse | 3520 Sykes Park Dr, Jackson, MS 39212 | 2017-04-12 |
| 1780044438 | Alfonzo Haralson | Counselor | 132 Thousand Oaks Cir, Jackson, MS 39212-2046 | 2016-02-24 |
| 1649819590 | George Cavett Jr. | Nurse Practitioner | 2450 Twisted Oak Dr, Jackson, MS 39212-2137 | 2019-12-24 |
| 1912455361 | Victorious Healthcare L.L.C. | Assisted Living Facility | 4959 Laurel Oak Dr, Jackson, MS 39212-2150 | 2016-09-14 |
| 1235523549 | Chanda M Rhodes | Counselor | 125 Cedarwood Dr, Jackson, MS 39212-2208 | 2015-03-25 |
| Find all providers in zip 39212 | ||||
| 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 |
|---|---|---|---|---|
| 1235754995 | Oak Street Health Physicians Group of Mississippi, LLC | Family Medicine | 911 Ellis Ave, Jackson, MS 39209 | 2020-06-09 |
| 1003470758 | Central Mississippi Health Services, Inc | Family Medicine | 3450 Highway 80 W Ste 71, Jackson, MS 39209-7201 | 2019-04-29 |
| 1922515493 | Meaghan Schenk Johnson | Family Medicine | 2969 Curran Dr N # 200, Jackson, MS 39216-4121 | 2018-01-05 |
| 1740795731 | Emily Colleen Dunaway | Family Medicine | 1227 N State St # 101, Jackson, MS 39202-2002 | 2017-12-12 |
| 1679086367 | Hope Np House Call Practice | Family Medicine | 98 Grandview Ave, Jackson, OH 45640-9090 | 2017-11-16 |
| 1427585488 | Daniel Matthew Bender | Family Medicine | 455 W Broadway Ave, Jackson, WY 83001-8639 | 2017-05-21 |
| 1891235289 | Logan Hardin | Family Medicine | 1270 Union University Dr Ste A, Jackson, TN 38305-3856 | 2017-03-03 |
| 1255782843 | Seth Tyler Koehler | Family Medicine | 2600 E Main St, Jackson, MO 63755-2473 | 2016-06-25 |
| 1720495245 | Gopi Patel | Family Medicine | 27 S Cooks Bridge Rd Ste 2-1, Jackson, NJ 08527-2524 | 2014-07-16 |
| 1154735165 | Lk Physicians Services Pllc | Family Medicine | 36 Lake Pointe Dr, Jackson, TN 38305-8113 | 2014-06-17 |
| Find all providers in JACKSON | ||||
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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.