MALL SERVICES, LLC (NPI# 1063659340) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063659340 |
| Entity Type | Organization |
| Organization Name | MALL SERVICES, LLC |
| Other Organization Name | 809 CONVENIENT CARE CLINIC |
| Practice Address |
809 N State St Jackson MS 39202-2604 |
| Mailing Address |
350 W Woodrow Wilson Ave Suite 615 Jackson MS 39213-7681 |
| Practice Telephone | 6019820673 |
| Practice Fax Number | 6019820459 |
| Mailing Telephone | 6019820673 |
| Mailing Fax Number | 6019820459 |
| Enumeration Date | 2009-01-08 |
| Last Update Date | 2009-01-08 |
| Authorized Official Name | MRS. CHRISTAL ROGERS (OFFICE ASSISTANT) |
| Authorized Official Telephone | 6019820673 |
| Authorized Official Credential | LPN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 172V00000X | Community Health Worker | P320574 | MS | Other Service Providers |
| Y | 363LF0000X |
Nurse Practitioner Specialization: Family |
R656046 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 08406271 | 05 | |
| MS | 00115980 | 05 |
| Other Name | Type Code |
|---|---|
| 809 Convenient Care Clinic | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699005983 | Mall Services, LLC | Family Medicine | 386 Raymond Rd, Building 30, Jackson, MS 39204-3700 | 2010-01-08 |
| 1568628980 | Mall Services, LLC | Clinic/Center | 2050 Martin Luther King Jr Dr, Jackson, MS 39203-1030 | 2008-08-05 |
| 1841456472 | Mall Services, LLC | Clinic/Center | 1066 Wiggins Road, Jackson, MS 39209 | 2008-08-04 |
| 1548539117 | Mall Services, LLC | Clinic/Center | 1860 Chadwick Dr, Suite 305, Jackson, MS 39204-3463 | 2011-12-27 |
| 1245477165 | Mall Services, LLC | Clinic/Center | 350 W Woodrow Wilson Ave, Suite 615, Jackson, MS 39213-7681 | 2009-01-14 |
| 1881878577 | Mall Services, LLC | Clinic/Center | 833 Maple St, Jackson, MS 39203-3844 | 2007-12-18 |
| 1285700617 | Mall Services, LLC | Clinic/Center | 350 W Woodrow Wilson Ave, Suite 615, Jackson, MS 39213-7681 | 2006-11-28 |
| Street Address |
809 N STATE ST |
| City | JACKSON |
| State | MS |
| Zip Code | 39202-2604 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861935546 | Cortney Dearman | Physical Therapy Assistant | 809 N State St, Jackson, MS 39202-2604 | 2016-11-29 |
| 1811287410 | Rebecca Lee Reynolds | Occupational Therapy Assistant | 809 N State St, Jackson, MS 39202-2604 | 2011-04-15 |
| 1083860688 | Complete Physical Therapy, LLC | Clinic/Center | 809 N State St, Jackson, MS 39202-2604 | 2008-08-14 |
| 1235184169 | Niki T.s Singletary | Physical Therapist | 809 N State St, Jackson, MS 39202-2604 | 2006-05-22 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1750868691 | Katherine Walters | Nurse Practitioner | 501 Marshall St., Suite 400, Jackson, MS 39202 | 2018-07-24 |
| 1932638749 | Tylan Lee | Social Worker | 860 East River Place Suite 100, Jackson, MS 39202 | 2017-06-06 |
| 1417314725 | Euna Jyles | Counselor | 860 E River Pl, Jackson, MS 39202 | 2016-01-19 |
| 1255712048 | Edward Jonathan Breight | Specialist/Technologist | 1325 East Fortication Street, Jackson, MS 39202 | 2015-06-17 |
| 1881037703 | Kara Spinks Logan | Surgery | 1190 N State St Ste 502, Jackson, MS 39202 | 2013-04-10 |
| 1477876530 | Mick Inc. | Technician | 334 Josanna Street, Suite #209, Jackson, MS 39202 | 2010-03-03 |
| 1073724910 | Paul Frederic Dare | Anesthesiology | 1151 North State St., Suite 311, Jackson Anesthesia Associates, Jackson, MS 39202 | 2007-05-24 |
| 1225247703 | Lynn Kincannon Holland | Counselor | 911 Manship Street, Unit A, Jackson, MS 39202 | 2007-05-22 |
| 1457568149 | Incare Inc | Pulmonary Function Technologist | 1151 North State St, Suite 406, Jackson, MS 39202 | 2007-05-16 |
| Find all providers in zip 39202 | ||||
| Taxonomy Code | 363LF0000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Family |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073113627 | Jessicah Blasdel | Nurse Practitioner | 113 W Michigan Ave, Jackson, MI 49201-1340 | 2020-10-31 |
| 1801406335 | Jade Russell | Nurse Practitioner | 2205 W Morrell St, Jackson, MI 49203-1357 | 2020-08-10 |
| 1992315212 | Patrecia Campbell | Nurse Practitioner | 2570 Bailey Ave Ste 7, Jackson, MS 39213-6905 | 2020-08-01 |
| 1669008926 | Kristine Edwards | Nurse Practitioner | 723 Woodlawn Ave, Jackson, MI 49203-2921 | 2020-03-19 |
| 1295366391 | Christy White | Nurse Practitioner | 363 Old Pinson Rd, Jackson, TN 38301-9576 | 2020-01-28 |
| 1972141620 | Primary Care - Bemis, LLC | Nurse Practitioner | 1385 S Highland Ave Ste B4, Jackson, TN 38301-7547 | 2019-12-12 |
| 1174164263 | Tami Anne Miller | Nurse Practitioner | 124 N Bast St, Jackson, MO 63755-1704 | 2019-10-01 |
| 1265080584 | Cameron Nicole Howard | Nurse Practitioner | 1860 Chadwick Dr Ste 256, Jackson, MS 39204-3486 | 2019-08-29 |
| 1831750843 | Rhiannon Michelle Andresen | Nurse Practitioner | 1022 Greystone Sq, Jackson, TN 38305-3580 | 2019-06-21 |
| 1902376361 | Jenay B Krumm | Nurse Practitioner | 1201 E Michigan Ave Ste 200, Jackson, MI 49201-1855 | 2018-11-28 |
| Find all providers in JACKSON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.