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MISSISSIPPI MEDICAL CLINIC
NPI 1114694536
Nurse Practitioner - Family in Taylorsville, MS

Active since August 24, 2021CLIA Certified · 2 labs
403 PINE ST, TAYLORSVILLE, MS 39168(601) 452-7080(601) 452-7083 Get Directions Write a Review

NPPES record last updated: April 25, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Apr 25, 2022, Dec 2, 2021, Aug 24, 2021 (3 updates tracked since 2021).

About Mississippi Medical Clinic NPPES

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

MISSISSIPPI MEDICAL CLINIC (NPI 1114694536) is a healthcare organization registered as a family in Taylorsville, Mississippi and active in the NPI registry since August 2021. The organization holds 2 active CLIA laboratory certificates, maintains a secondary practice location in Mendenhall, and lists Patty Bullock, Np Managing Partner, as its authorized official.

NPPES Registry Identity

NPI1114694536
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameMISSISSIPPI MEDICAL CLINIC
Location Address403 PINE STTaylorsville, MS 39168-5659
Mailing Address403 Pine StTaylorsville, MS 39168-5659 · (601) 452-7080 · Fax (601) 452-7083
Phone(601) 452-7080
Fax(601) 452-7083
Organization SubpartNo
Authorized OfficialPatty BullockNp Managing Partner · (601) 452-7080
Enumeration DateAugust 24, 2021
Last NPPES UpdateApril 25, 20223 updates tracked since enumeration
NPPES CertifiedApril 11, 2022
✔ NPI 1114694536 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
403 PINE ST, Taylorsville, MS 39168
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Secondary Practice Location 1

Location 12170 Simpson Hwy 49Mendenhall, MS 39114 · Phone (601) 452-7080

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 2

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 25D2258845

Mississippi Medical Clinic · Mendenhall, MS
Active · expires Apr 26, 2028
CLIA Number25D2258845
Laboratory TypePractitioner Other
Certificate Effective DateApril 27, 2026
Certificate Expiration DateApril 26, 2028
Laboratory DirectorChante Ferguson
Laboratory Phone(601) 452-7080
Laboratory LocationMississippi Medical Clinic2170 Simpson Hwy 49, Mendenhall, MS 39114
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 25D2233932

Mississippi Medical Clinic · Taylorsville, MS
Active · expires Aug 25, 2027
CLIA Number25D2233932
Laboratory TypePractitioner Other
Certificate Effective DateAugust 26, 2025
Certificate Expiration DateAugust 25, 2027
Laboratory DirectorPatricia Bullock
Laboratory Phone(601) 498-9994
Laboratory LocationMississippi Medical Clinic403 Pine St, Taylorsville, MS 39168
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 3

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

CHANTE NICOLE FERGUSON
Nurse Practitioner (Family)
403 PINE ST
TAYLORSVILLE, MS 39168
Smith County (601) 452-7080
JFMC TAYLORSVILLE, LLC
Clinic/Center (Primary Care)
403 PINE ST
TAYLORSVILLE, MS 39168
Smith County (601) 478-5020
PATRICIA BULLOCK NP-C
Nurse Practitioner (Family)
403 PINE ST
TAYLORSVILLE, MS 39168
Smith County (601) 452-7080

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 Mississippi Medical Clinic's NPI number?

The NPI number for Mississippi Medical Clinic is 1114694536. It was assigned to this organization in the NPPES registry on August 24, 2021.

Where is Mississippi Medical Clinic located?

Mississippi Medical Clinic is located at 403 Pine St, Taylorsville, MS 39168. The listed phone number is (601) 452-7080.

What is Mississippi Medical Clinic's specialty?

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

Does Mississippi Medical Clinic hold CLIA laboratory certificates?

Yes. 2 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

What insurance does Mississippi Medical Clinic 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 and 1 other insurer list Mississippi Medical Clinic 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 Mississippi Medical Clinic was last updated on April 25, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 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.