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OLD TOWNE MEDICAL
NPI 1013312172
Nurse Practitioner - Family in Olive Branch, MS

Active since October 30, 2014CLIA 25D2086325 · Waiver
9066 HIGHLAND ST, OLIVE BRANCH, MS 38654(662) 890-7717(662) 874-6038 Get Directions Write a Review

NPPES record last updated: July 30, 2019. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Old Towne Medical NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

OLD TOWNE MEDICAL (NPI 1013312172) is a healthcare organization registered as a family in Olive Branch, Mississippi and active in the NPI registry since October 2014. The organization holds a CLIA Waiver certificate valid through October 30, 2026 and lists Susan C Brame, Owner, as its authorized official.

NPPES Registry Identity

NPI1013312172
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameOLD TOWNE MEDICAL LLC
Location Address9066 HIGHLAND STOlive Branch, MS 38654-2307
Mailing Address9066 Highland StOlive Branch, MS 38654-2307 · (662) 890-7717 · Fax (662) 874-6038
Phone(662) 890-7717
Fax(662) 874-6038
Organization SubpartNo
Authorized OfficialSusan C BrameOwner · (901) 489-6595
Enumeration DateOctober 30, 2014
Last NPPES UpdateJuly 30, 2019
✔ NPI 1013312172 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in MS · R644986
9066 HIGHLAND ST, Olive Branch, MS 38654
Open in Google Maps ↗

Other Names 1

Doing Business AsOld Towne Medical

Other Identifiers 1

Medicaid03278318MS

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 25D2086325

Old Towne Medical LLC · Olive Branch, MS
Active · expires Oct 30, 2026
CLIA Number25D2086325
Laboratory TypePractitioner Other
Certificate Effective DateOctober 31, 2024
Certificate Expiration DateOctober 30, 2026
Laboratory DirectorSusan Brame
Laboratory Phone(662) 874-6164
Laboratory LocationOld Towne Medical LLC9066 Highland Street, Olive Branch, MS 38654
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MOLLIE JO KINARD FNP-C
Nurse Practitioner (Family)
9066 HIGHLAND ST
OLIVE BRANCH, MS 38654
Desoto County (662) 890-7717
SUSAN C BRAME FNP
Nurse Practitioner (Family)
9066 HIGHLAND ST
OLIVE BRANCH, MS 38654
Desoto County (662) 890-7717

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Old Towne Medical LLC's NPI number?

The NPI number for Old Towne Medical LLC is 1013312172. It was assigned to this organization in the NPPES registry on October 30, 2014. The provider is doing business as Old Towne Medical.

Where is Old Towne Medical LLC located?

Old Towne Medical LLC is located at 9066 Highland St, Olive Branch, MS 38654. The listed phone number is (662) 890-7717.

What is Old Towne Medical LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Does Old Towne Medical LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2086325) is associated with this NPI, valid through October 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Old Towne Medical LLC accept?

Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of Tennessee list Old Towne Medical LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Old Towne Medical LLC was last updated on July 30, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.