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1245170885 NPI number — JOURNEYCARE MEDICAL

NPI Number: 1245170885
Health Care Provider/Practitioner: JOURNEYCARE MEDICAL

Information about “1245170885” NPI (JOURNEYCARE MEDICAL) exists in 1245170885 in HTML format HTML  |  1245170885 in plain Text format TXT  |  1245170885 in PDF (Portable Document Format) PDF  |  1245170885 in an XML format XML  formats.

NPI Number : 1245170885 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1245170885",
    "EntityType": "Organization",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": null,
    "IsOrgSubpart": "N",
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": "JOURNEYCARE MEDICAL",
    "LastName": null,
    "FirstName": null,
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1023 WINDMILL DR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "BYRAM",
    "MailingAddressStateName": "MS",
    "MailingAddressPostalCode": "39272-4469",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "601-376-8019",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "350 W WOODROW WILSON AVE STE 3010",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "JACKSON",
    "PracticeLocationAddressStateName": "MS",
    "PracticeLocationAddressPostalCode": "39213-7681",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "601-376-8019",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "04/01/2026",
    "LastUpdateDate": "04/01/2026",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": null,
    "Gender": null,
    "AuthorizedOfficialLastName": "NICHOLS-BATES",
    "AuthorizedOfficialFirstName": "SHANTRICE",
    "AuthorizedOfficialMiddleName": "BERNICE",
    "AuthorizedOfficialTitle": "CEO/MEDICAL DIRECTOR",
    "AuthorizedOfficialNamePrefix": "DR.",
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": "DNP",
    "AuthorizedOfficialTelephoneNumber": "601-376-8019",
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "363LP2300X",
        "TaxonomyName": "Primary Care Nurse Practitioner",
        "LicenseNumber": null,
        "LicenseNumberStateCode": null,
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": {
      "HealthcareProviderTaxonomyGroup": {
        "HealthcareProviderTaxonomyGroupName": "193200000X MULTI-SPECIALTY GROUP",
        "HealthcareProviderTaxonomyGroupDescription": "Multi-Specialty Group - A business group of one or more individual practitioners, who practice with different areas of specialization."
      }
    }
  }
}
                
            

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