=====================================================
General NPI Number Information
=====================================================
NPI Number | 1801652904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLEMING FAMILY WELLNESS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2024
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2416 HIGHWAY 43 S
-----------------------------------------------------
City | PICAYUNE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39466-7415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 769-242-2525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 265 MAGNOLIA DR
-----------------------------------------------------
City | PICAYUNE
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39466-8717
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-916-6178
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FNP
-----------------------------------------------------
Name | MATTHEW BLAKE FLEMING
-----------------------------------------------------
Credential | FNP
-----------------------------------------------------
Telephone | 601-916-6178
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261Q00000X
-----------------------------------------------------
Taxonomy Name | Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------