CHARLESTON CLINIC (NPI# 1831329887) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1831329887 |
| Entity Type | Organization |
| Organization Name | CHARLESTON CLINIC |
| Practice Address |
401 S Church St Charleston MS 38921-2257 |
| Mailing Address |
P. O. Box 21 Charleston MS 38921 |
| Practice Telephone | 6626475816 |
| Enumeration Date | 2009-07-23 |
| Last Update Date | 2011-07-06 |
| Authorized Official Name | MRS. LISA SUDDUTH BRADHAM (NURSE PRACTITIONER) |
| Authorized Official Telephone | 6626475816 |
| Authorized Official Credential | FNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LC1500X |
Nurse Practitioner Specialization: Community Health |
R865030 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
401 S CHURCH ST |
| City | CHARLESTON |
| State | MS |
| Zip Code | 38921-2257 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477644466 | Yolanda K Berkley | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2006-09-27 |
| 1013559426 | Jessica Elizabeth Mcgee | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2019-10-17 |
| 1447891692 | Audrey Leann Williamson | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2019-09-30 |
| 1679124713 | Catherine Moring | Dietitian, Registered | 401 S Church St, Charleston, MS 38921-2257 | 2019-09-20 |
| 1417425620 | Raedena L Hill | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2018-11-06 |
| 1134596919 | Cassala Ward | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2015-08-27 |
| 1801287883 | Shana Belle Smith | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2015-02-11 |
| 1457796922 | Monica Joy Carter | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2013-05-09 |
| 1568766145 | Lisa Bradham | Nurse Practitioner | 401 S Church St, Charleston, MS 38921-2257 | 2010-12-22 |
| 1649477191 | Robert L. Carter | Emergency Medicine | 401 S Church St, Charleston, MS 38921-2257 | 2007-06-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538717459 | Square Drugs, LLC | Pharmacy | 126 Court Square, Charleston, MS 38921 | 2019-09-04 |
| 1588015341 | Kyle Wiggins | Dentist | 203 South Market St, Charleston, MS 38921 | 2016-06-23 |
| 1659555761 | Tallahatchie General Hospital and Extended Care Facility | Nursing Facility/Intermediate Care Facility | 201 South Market Street, Charleston, MS 38921 | 2007-12-26 |
| 1316152010 | Wolfe Family Medical Clinic Pllc | Clinic/Center | 203 E Walnut St, Charleston, MS 38921 | 2007-05-14 |
| 1962617530 | East Tallahatchie Schools | Registered Nurse | 35 Oak Grove Road, Charleston, MS 38921 | 2007-05-14 |
| 1518052661 | Carlene Maynor Wolfe | Nurse Practitioner | 204 East Walnut Street, Charleston, MS 38921 | 2006-10-04 |
| 1003921172 | James Oscar Wilde Jr. | Family Medicine | 201 S. Market St., Charleston, MS 38921 | 2006-08-20 |
| 1851919658 | Delta Med South, Inc. | Durable Medical Equipment & Medical Supplies | 7 Court Sq, Charleston, MS 38921 | 2020-07-08 |
| 1932616950 | Sharon Bradley | Homemaker | 29 Nell St, Charleston, MS 38921-1424 | 2017-12-30 |
| 1649595505 | Lasuna M Curry | Counselor | 17 N Market St, Charleston, MS 38921-1524 | 2010-04-05 |
| Find all providers in zip 38921 | ||||
| Taxonomy Code | 363LC1500X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Community Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861431660 | Carlon J. Mitchell | Nurse Practitioner | 4050 Bridge View Dr, Charleston, SC 29405-8415 | 2006-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013426329 | Fig Leaf, LLC | Nurse Practitioner | 171 South St, Caledonia, MS 39740 | 2017-09-29 |
| 1386197697 | Scott Fowler | Nurse Practitioner | 117 S 11th Ave, Laurel, MS 39440-4312 | 2016-08-03 |
| 1568598027 | Ericka M Micou | Nurse Practitioner | 1134 Winter St, Jackson, MS 39204-2841 | 2007-02-26 |
| City | CHARLESTON |
| Zip Code | 38921 |
Please comment or provide details below to improve the information on CHARLESTON CLINIC.
| 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.