MISSISSIPPI ASTHMA & ALLERGY CLINIC PA (NPI# 1902882251) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1902882251 |
| Entity Type | Organization |
| Organization Name | MISSISSIPPI ASTHMA & ALLERGY CLINIC PA |
| Practice Address |
1513 Lakeland Dr Ste 100 Jackson MS 39216-4829 |
| Mailing Address |
1513 Lakeland Dr Ste 101 Jackson MS 39216-4829 |
| Practice Telephone | 6013544836 |
| Practice Fax Number | 6013542619 |
| Mailing Telephone | 6013544836 |
| Mailing Fax Number | 6013542619 |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2010-02-16 |
| Authorized Official Name | MR. DAVID L MOAK (PRACTICE ADMINISTRATOR) |
| Authorized Official Telephone | 6013544836 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207K00000X | Allergy & Immunology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | RR MEDICARE | 030001646 | 01 |
| MS | RR MEDICARE | P00236071 | 01 |
| MS | RR MEDICARE | 030002483 | 01 |
| MS | RR MEDICARE | 030003287 | 01 |
| Street Address |
1513 LAKELAND DR STE 100 |
| City | JACKSON |
| State | MS |
| Zip Code | 39216-4829 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003375197 | Robert Caleb Cauthen | Counselor | 1513 Lakeland Dr, Jackson, MS 39216-4829 | 2019-03-18 |
| 1154897858 | Monica Roberts | Counselor | 1513 Lakeland Dr, Jackson, MS 39216-4829 | 2018-10-19 |
| 1700361763 | Laura Katherine Barker | Behavioral Analyst | 1513 Lakeland Dr, Jackson, MS 39216-4829 | 2018-09-26 |
| 1528543584 | Robyn Riley Brewer | Behavioral Analyst | 1513 Lakeland Dr, Jackson, MS 39216-4829 | 2018-09-26 |
| 1124315742 | Claire Brabec Rosenblatt | Allergy & Immunology | 1513 Lakeland Dr, Suite 101, Jackson, MS 39216-4829 | 2011-07-03 |
| 1902025752 | The Children's Clinic, Pllc | Pediatrics | 1513 Lakeland Dr, Suite 101, Jackson, MS 39216-4829 | 2007-04-24 |
| 1942424734 | Medical Foundation of Central Mississippi, Inc | Family Medicine | 1513 Lakeland Dr, Suite 200, Jackson, MS 39216-4829 | 2007-04-12 |
| 1083789937 | Bryant Ridgway Boswell | Dentist | 1513 Lakeland Dr, Suite 201, Jackson, MS 39216 | 2006-11-22 |
| 1710965694 | James R Haltom | Allergy & Immunology | 1513 Lakeland Dr, Ste 101, Jackson, MS 39216-4829 | 2006-01-03 |
| 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 | 207K00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Allergy & Immunology |
| An allergist-immunologist is trained in evaluation, physical and laboratory diagnosis, and management of disorders involving the immune system. Selected examples of such conditions include asthma, anaphylaxis, rhinitis, eczema, and adverse reactions to drugs, foods, and insect stings as well as immune deficiency diseases (both acquired and congenital), defects in host defense, and problems related to autoimmune disease, organ transplantation, or malignancies of the immune system. |
| Notes: Source: American Board of Medical Specialties, 2007, www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Allergy and Immunology, 2007. http://www.abai.org/ No subspecialty certificates in allergy and immunology are offered by the American Board of Allergy and Immunology (ABAI). The ABAI, however, does offer formal special pathways for physicians seeking dual certification in allergy/immunology and pediatric pulmonology; allergy/immunology and pediatric rheumatology; and allergy/immunology and adult rheumatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295226157 | Jackson Allergy & Asthma Clinic Pllc | Allergy & Immunology | 464 N Parkway Ste D, Jackson, TN 38305-2810 | 2018-05-25 |
| 1689803918 | Patricia Honea Stewart | Allergy & Immunology | 878 Lakeland Dr., Lb-building, Jackson, MS 39216-4500 | 2009-07-08 |
| 1154529709 | Chelle P Wilhelm | Allergy & Immunology | 1513 Lakeland Dr Ste 101, Jackson, MS 39216-4829 | 2007-07-05 |
| 1407955537 | Joshua F Phillips | Allergy & Immunology | 1513 Lakeland Dr., Suite 101, Jackson, MS 39216 | 2006-09-22 |
| 1003892357 | Daniel L Venarske | Allergy & Immunology | 1513 Lakeland Dr., Suite 101, Jackson, MS 39216 | 2005-12-19 |
| 1598750184 | Alan C Dejarnatt | Allergy & Immunology | 464 N Parkway, Suite D, Jackson, TN 38305-2810 | 2005-09-20 |
| 1124315742 | Claire Brabec Rosenblatt | Allergy & Immunology | 1513 Lakeland Dr, Suite 101, Jackson, MS 39216-4829 | 2011-07-03 |
| 1982893939 | University Physicians | Allergy & Immunology | 1410 E Woodrow Wilson Ave, Jackson, MS 39216-5114 | 2007-10-16 |
| 1215159793 | Jackson Asthma & Allergy Center, Pa | Allergy & Immunology | 5903 Ridgewood Road, Suite 430, Jackson, MS 39211-3702 | 2007-05-03 |
| 1548204746 | Stephen F Kemp | Allergy & Immunology | 878 Lakeland Dr, Lb-building, Jackson, MS 39216-4500 | 2006-06-16 |
| 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.