| The Chadwick Clinic Llc | |
|
609 Brunson Dr Ste B Tupelo MS 38801-4948 | |
| (662) 432-1097 | |
| (662) 432-1098 |
| Full Name | The Chadwick Clinic Llc |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 609 Brunson Dr Ste B, Tupelo, Mississippi |
| Authorized Official Name and Position | Beth Clardy (MANAGER) |
| Authorized Official Contact | 6628710911 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| The Chadwick Clinic Llc Po Box 480 Corinth MS 38835-0480 Ph: () - | The Chadwick Clinic Llc 609 Brunson Dr Ste B Tupelo MS 38801-4948 Ph: (662) 432-1097 |
| NPI Number | 1801538186 |
|---|---|
| Provider Enumeration Date | 04/08/2022 |
| Last Update Date | 05/10/2022 |
| Certification Date | 05/10/2022 |
| Medicare PECOS PAC ID | 5092198028 |
|---|---|
| Medicare Enrollment ID | O20220823004048 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1801538186 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Amanda L Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356538045 PECOS PAC ID: 5294805578 Enrollment ID: I20080529000153 |
| Provider Name | Jennifer K. Warren |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1356707400 PECOS PAC ID: 9436457082 Enrollment ID: I20160414000707 |
| Provider Name | Tabitha Harper |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801375894 PECOS PAC ID: 9537408554 Enrollment ID: I20190308000119 |
| Provider Name | Derrick Pringle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1518481480 PECOS PAC ID: 0840532719 Enrollment ID: I20190424001198 |
| Provider Name | Sherita Danielle Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225502412 PECOS PAC ID: 6103168083 Enrollment ID: I20190424001787 |
| Provider Name | Glenn Ellis |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1184712820 PECOS PAC ID: 9234465881 Enrollment ID: I20190927000736 |
| Provider Name | Kerri Jo Whittington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275007510 PECOS PAC ID: 0840694667 Enrollment ID: I20210802001135 |
| Provider Name | Paige Westmoreland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932792207 PECOS PAC ID: 6305244906 Enrollment ID: I20211012003490 |
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