| Mcfatter Family Medical, Llc | |
|
710 Highland Colony Pkwy Ste A Ridgeland MS 39157-8701 | |
| (601) 398-9886 | |
| (601) 398-9885 |
| Full Name | Mcfatter Family Medical, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 710 Highland Colony Pkwy Ste A, Ridgeland, Mississippi |
| Authorized Official Name and Position | Daniel Hurley Mcfatter (OWNER) |
| Authorized Official Contact | 6013989886 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mcfatter Family Medical, Llc 305 Covington Cv Madison MS 39110-4581 Ph: (601) 398-9886 | Mcfatter Family Medical, Llc 710 Highland Colony Pkwy Ste A Ridgeland MS 39157-8701 Ph: (601) 398-9886 |
| NPI Number | 1811660293 |
|---|---|
| Provider Enumeration Date | 07/30/2021 |
| Last Update Date | 10/26/2023 |
| Medicare PECOS PAC ID | 0648678185 |
|---|---|
| Medicare Enrollment ID | O20211013001759 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811660293 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 261QU0200X | Clinic/center - Urgent Care | (* (Not Available)) | Primary |
| Provider Name | William Castle |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538138391 PECOS PAC ID: 8729973573 Enrollment ID: I20040219000559 |
| Provider Name | Barbara Kendrick |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134152424 PECOS PAC ID: 0244286862 Enrollment ID: I20050328000329 |
| Provider Name | Lyndsey Fry Carlton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518369180 PECOS PAC ID: 9436472891 Enrollment ID: I20141216002500 |
| Provider Name | Clinton Walker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124417761 PECOS PAC ID: 7719203769 Enrollment ID: I20150310000938 |
| Provider Name | Antonella T Marchionna |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1790180107 PECOS PAC ID: 9436464633 Enrollment ID: I20150818003574 |
| Provider Name | Meghan Blankenship Watson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205307543 PECOS PAC ID: 2062759640 Enrollment ID: I20190122001145 |
| Provider Name | Natalie Kathleen Pace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295370088 PECOS PAC ID: 6507256062 Enrollment ID: I20211124001358 |
| Provider Name | Jonathan A Giangrosso |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972113439 PECOS PAC ID: 4284013251 Enrollment ID: I20220622000377 |
| Provider Name | Virginia Caitlin Gill |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558097444 PECOS PAC ID: 7113395914 Enrollment ID: I20221129002382 |
| Provider Name | Ivey Burt Shelton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1407573843 PECOS PAC ID: 2567831100 Enrollment ID: I20221203000233 |
| Provider Name | Lauren Mize |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598414765 PECOS PAC ID: 3476927625 Enrollment ID: I20230329003524 |
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