DAMON BAGLEY-AYRES (NPI# 1497126775) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497126775 |
| Entity Type | Individual |
| Full Name | DAMON BAGLEY-AYRES |
| Credential | CPO |
| Practice Address |
777 Lakeland Dr Jackson MS 39216-4611 |
| Practice Telephone | 6018154844 |
| Practice Fax Number | 6018154592 |
| Mailing Telephone | 6018154844 |
| Mailing Fax Number | 6018154592 |
| Enumeration Date | 2015-10-13 |
| Last Update Date | 2016-06-09 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 222Z00000X | Orthotist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 224P00000X | Prosthetist | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Street Address |
777 LAKELAND DR |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4611 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538258736 | Rick A Psonak | Orthotist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2006-10-12 |
| 1790091411 | April Webb | Speech-Language Pathologist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2010-08-19 |
| 1548583172 | Charles Reggie Kennedy Sr. | Orthotist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2010-03-10 |
| 1285956482 | Michelle Andrea Lowrie | Speech-Language Pathologist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2010-02-16 |
| 1487806899 | Josephine Pillow Duke | Speech-Language Pathologist | 777 Lakeland Dr, Jackson, MS 39216-4611 | 2008-10-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861011553 | Ashley Melancon Prewitt | Registered Nurse | St. Dominic's North Campus, Behavioral Health, Jackson, MS 39216 | 2020-04-13 |
| 1194353391 | Brianna Arrington | Student in an Organized Health Care Education/Training Program | Med/ Peds, 2500 N. State St., Jackson, MS 39216 | 2020-04-01 |
| 1720616485 | Roshina Khalid Khan | Student in an Organized Health Care Education/Training Program | Department of Anesthesiology, Ummc, 2500 N. State St., Jackson, MS 39216 | 2020-03-30 |
| 1275183550 | Amanda Lynn Morellato | Dentist | Ummc School of Dentistry, 2500 North State Street, Jackson, MS 39216 | 2019-09-18 |
| 1396305553 | Abhishek Chhabra | Student in an Organized Health Care Education/Training Program | Lakeland Family Medicine Clinic, 878 Lakeland Dr., Jackson, MS 39216 | 2019-06-19 |
| 1427615996 | Hometown Diagnostics | Clinical Medical Laboratory | Translational Research Center Tr311, 2500 North State Street, Jackson, MS 39216 | 2019-05-21 |
| 1346807773 | Shukundala C Smith | Behavior Technician | New Learning Resources 2510 Lakeland Terrace, Jackson, MS 39216 | 2019-05-21 |
| 1063901098 | G Eli Howell Md Pllc | Plastic Surgery | 971 Lakeland Dr Ste 225, Jackson, MS 39216 | 2018-05-04 |
| 1588168132 | Caleb Zumbro | Student in an Organized Health Care Education/Training Program | Ummc Med/peds, 2500 N. State St., Jackson, MS 39216 | 2018-03-20 |
| 1639677230 | Walgreen Co | Pharmacy | 971 Lakeland Dr Ste 101, Jackson, MS 39216 | 2018-01-29 |
| Find all providers in zip 39216 | ||||
| Taxonomy Code | 224P00000X |
| Grouping | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
| Classification | Prosthetist |
| A health care professional who is specifically educated and trained to manage comprehensive prosthetic patient care for individuals who have sustained complete or partial limb loss or absence. Prosthetists assess specific patient needs, formulate an appropriate treatment plan, implement the treatment plan and provide follow-up care. |
| Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194909069 | Richard C Boleware | Prosthetist | 2 Old River Pl Ste D, Jackson, MS 39202-3435 | 2007-12-27 |
| 1427042134 | Buckner Prosthetic and Orthotic Laboratories Inc. | Prosthetist | 2 Old River Pl, Suite D, Jackson, MS 39202-3435 | 2005-09-08 |
| 1871887653 | Stephen James Singleton | Prosthetist | 2 Old River Pl, Suite D, Jackson, MS 39202-3435 | 2011-06-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285247783 | Jay Michael Rubenstein | Prosthetist | 3004 Bienville Blvd Ste 1, Ocean Springs, MS 39564-4370 | 2020-08-25 |
| 1750906301 | Denisha Louise Williams | Prosthetist | 828 Pass Rd Ste C, Gulfport, MS 39501-6437 | 2020-06-10 |
| 1538795364 | Faithful Limbs Prosthetics | Prosthetist | 114 Herring Dr, Raymond, MS 39154-9646 | 2020-03-12 |
| 1801428438 | Kimberly Toler | Prosthetist | 8225 Barberry Pl, Southaven, MS 38671-4203 | 2020-02-11 |
| 1194287953 | Brianna Marshall | Prosthetist | 100 Shelby Street, Beulah, MS 38726 | 2019-04-02 |
| 1386106375 | Nicole Clark | Prosthetist | 100 N Burke Ave, Long Beach, MS 39560-4605 | 2019-04-01 |
| 1023576972 | Synterika Shanta Welch | Prosthetist | 7164 Hacks Cross Rd, Olive Branch, MS 38654-4472 | 2019-03-11 |
| 1295203602 | Joanetta Marie Williams | Prosthetist | 806 S 28th Ave, Hattiesburg, MS 39402-2601 | 2018-11-05 |
| 1174888457 | Philip Anthony Bickert | Prosthetist | 2106s Tate St, Corinth, MS 38834-7913 | 2012-07-12 |
| 1285848846 | Douglas Santrell Banks | Prosthetist | 199 Charmant Pl, Suite 4, Ridgeland, MS 39157-4358 | 2007-05-10 |
| Find all providers with the same taxonomy | ||||
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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.