IVYRAINE WOMEN'S CLINIC
NPI 1962166264
Nurse Practitioner - Women's Health in Southaven, MS

Q: What is Ivyraine Women's Clinic's NPI number?

The NPI number for Ivyraine Women's Clinic is 1962166264. It was assigned to this organization in the NPPES registry on October 24, 2021.

Q: What is Ivyraine Women's Clinic's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Women's Health, with taxonomy code 363LW0102X.

Active since October 24, 2021CLIA 25D2243740 · Microscopy

3964 GOODMAN RD E STE 131, SOUTHAVEN, MS 38672(662) 856-8440 Get Directions Write a Review

NPPES record last updated: December 29, 2021. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Dec 29, 2021, Dec 1, 2021, Oct 24, 2021 (3 updates tracked since 2021).

On this page

About Ivyraine Women's Clinic NPPES

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

IVYRAINE WOMEN'S CLINIC (NPI 1962166264) is a healthcare organization registered as a women's health in Southaven, Mississippi and active in the NPI registry since October 2021. The organization holds a CLIA Microscopy certificate valid through March 7, 2028 and lists Jennifer Fredrickson, Np, as its authorized official.

NPPES Registry Identity

NPI1962166264

Entity TypeOrganization

Primary Taxonomy363LW0102X

Legal Business NameIVYRAINE WOMEN'S CLINIC

Location Address3964 GOODMAN RD E STE 131Southaven, MS 38672-8762

Mailing Address3964 Goodman Rd E Ste 131Southaven, MS 38672-8762 · (662) 856-8440

Phone(662) 856-8440

Organization SubpartNo

Authorized OfficialJennifer FredricksonNp · (662) 856-8440

Enumeration DateOctober 24, 2021

Last NPPES UpdateDecember 29, 20213 updates tracked since enumeration

NPPES CertifiedDecember 29, 2021

✔ NPI 1962166264 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · Women's HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LW0102X

3964 GOODMAN RD E STE 131, Southaven, MS 38672

Open in Google Maps ↗

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 for Provider-Performed Microscopy Procedures (PPMP) 25D2243740

Ivyraine Women's Clinic · Southaven, MS

Active · expires Mar 7, 2028

CLIA Number25D2243740

Laboratory TypePractitioner Other

Certificate Effective DateMarch 8, 2026

Certificate Expiration DateMarch 7, 2028

Laboratory DirectorJennifer B. Fredrickson

Laboratory Phone(662) 856-8440

Laboratory LocationIvyraine Women's Clinic3964 Goodman Rd E Ste 131, Southaven, MS 38672

CLIA data matches this NPI record on: Address Name Phone

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Other Providers at the Same Location NPPES

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

JENNIFER B FREDRICKSON APN

Nurse Practitioner (Women's Health)

3964 GOODMAN RD E STE 131
SOUTHAVEN, MS 38672

Desoto County (662) 856-8440

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 Ivyraine Women's Clinic's NPI number?

The NPI number for Ivyraine Women's Clinic is 1962166264. It was assigned to this organization in the NPPES registry on October 24, 2021.

Where is Ivyraine Women's Clinic located?

Ivyraine Women's Clinic is located at 3964 Goodman Rd E Ste 131, Southaven, MS 38672. The listed phone number is (662) 856-8440.

What is Ivyraine Women's Clinic's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Women's Health, with taxonomy code 363LW0102X.

Does Ivyraine Women's Clinic hold a CLIA laboratory certificate?

Yes. A Certificate for Provider-Performed Microscopy Procedures (PPMP) (number 25D2243740) is associated with this NPI, valid through March 7, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Ivyraine Women's 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 list Ivyraine Women's 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 Ivyraine Women's Clinic was last updated on December 29, 2021. 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.