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GRAYSON CREEK MEDICAL CLINIC, LLC
NPI 1184166035
Nurse Practitioner - Pediatrics in Moselle, MS

Active since November 09, 2016CLIA 25D2122171 · Waiver
3 JOHN EVERETT RD, MOSELLE, MS 39459(601) 620-9991 Get Directions Write a Review

NPPES record last updated: October 19, 2017. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Oct 19, 2017, Jan 27, 2017, Nov 9, 2016 (3 updates tracked since 2016).

About Grayson Creek Medical Clinic, Llc NPPES

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

GRAYSON CREEK MEDICAL CLINIC, LLC (NPI 1184166035) is a healthcare organization registered as a pediatrics in Moselle, Mississippi and active in the NPI registry since November 2016. The organization holds a CLIA Waiver certificate valid through September 9, 2026 and lists Mack E Knight, Owner, as its authorized official.

NPPES Registry Identity

NPI1184166035
Entity TypeOrganization
Primary Taxonomy363LP0200X
Legal Business NameGRAYSON CREEK MEDICAL CLINIC, LLC
Location Address3 JOHN EVERETT RDMoselle, MS 39459-9771
Mailing Address3 John Everett RdMoselle, MS 39459-9771 · (601) 620-9991
Phone(601) 620-9991
Organization SubpartNo
Authorized OfficialMack E KnightOwner · (601) 408-9945
Enumeration DateNovember 9, 2016
Last NPPES UpdateOctober 19, 20173 updates tracked since enumeration
✔ NPI 1184166035 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · PediatricsPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LP0200X
License✔ Licensed in MS · 732001
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X · License 732001 (MS), 901749 (MS)
3 JOHN EVERETT RD, Moselle, MS 39459
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Other Identifiers 1

Medicaid0044232MS

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-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 25D2122171

Grayson Creek Medical Clinic · Moselle, MS
Active · expires Sep 9, 2026
CLIA Number25D2122171
Laboratory TypePractitioner Other
Certificate Effective DateSeptember 10, 2024
Certificate Expiration DateSeptember 9, 2026
Laboratory DirectorMs. Lori S. Galloway
Laboratory Phone(601) 620-9991
Laboratory LocationGrayson Creek Medical Clinic3 John Everett Rd, Moselle, MS 39459
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 5

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

LAURYN HICKS FNP-C
Nurse Practitioner (Family)
3 JOHN EVERETT RD
MOSELLE, MS 39459
Jones County (601) 620-9991
CARRIE M SMITH AU.D.
Audiologist
3 JOHN EVERETT RD
MOSELLE, MS 39459
Jones County (601) 475-9304
SMITH AUDIOLOGY, LLC
Audiologist
3 JOHN EVERETT RD
MOSELLE, MS 39459
Jones County (601) 475-9304
MACK E KNIGHT FNP-C
Nurse Practitioner (Family)
3 JOHN EVERETT RD
MOSELLE, MS 39459
Jones County (601) 620-9991
JENNIFER R SMITH FNP
Nurse Practitioner (Family)
3 JOHN EVERETT RD
MOSELLE, MS 39459
Jones County (601) 620-9991

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 Grayson Creek Medical Clinic, LLC's NPI number?

The NPI number for Grayson Creek Medical Clinic, LLC is 1184166035. It was assigned to this organization in the NPPES registry on November 9, 2016.

Where is Grayson Creek Medical Clinic, LLC located?

Grayson Creek Medical Clinic, LLC is located at 3 John Everett Rd, Moselle, MS 39459. The listed phone number is (601) 620-9991.

What is Grayson Creek Medical Clinic, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Pediatrics, with taxonomy code 363LP0200X.

Does Grayson Creek Medical Clinic, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 25D2122171) is associated with this NPI, valid through September 9, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Grayson Creek Medical Clinic, 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 and 1 other insurer list Grayson Creek Medical Clinic, 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 Grayson Creek Medical Clinic, LLC was last updated on October 19, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 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.