| My Brother's Keeper, Inc | |
|
805 E River Pl Jackson MS 39202-3486 | |
| (601) 500-7660 | |
| (769) 243-7946 |
| Full Name | My Brother's Keeper, Inc |
|---|---|
| Speciality | Clinic/Center |
| Location | 805 E River Pl, Jackson, Mississippi |
| Authorized Official Name and Position | June a Gipson (CEO) |
| Authorized Official Contact | 7692162455 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Brother's Keeper, Inc 805 E River Pl Jackson MS 39202-3486 Ph: (601) 500-7660 | My Brother's Keeper, Inc 805 E River Pl Jackson MS 39202-3486 Ph: (601) 500-7660 |
| NPI Number | 1609128339 |
|---|---|
| Provider Enumeration Date | 10/04/2012 |
| Last Update Date | 03/02/2022 |
| Certification Date | 03/02/2022 |
| Medicare PECOS PAC ID | 4082859004 |
|---|---|
| Medicare Enrollment ID | O20130322000283 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609128339 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| Provider Name | Keith Stokes |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1821297961 PECOS PAC ID: 8628148780 Enrollment ID: I20080531000013 |
| Provider Name | Jackie Denise Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831468305 PECOS PAC ID: 1759522329 Enrollment ID: I20130724000216 |
| Provider Name | Kristie Lashundra Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447632351 PECOS PAC ID: 1658680640 Enrollment ID: I20151013002158 |
| Provider Name | Melissa Minor |
|---|---|
| Provider Type | Practitioner - Physician Assistant |
| Provider Identifiers | NPI Number: 1588025373 PECOS PAC ID: 4880972678 Enrollment ID: I20161029000082 |
| Provider Name | Melissa Yvonne White |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033643432 PECOS PAC ID: 7618246752 Enrollment ID: I20170816002914 |
| Provider Name | Brittany E Brooks |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750641759 PECOS PAC ID: 8921397951 Enrollment ID: I20180612000461 |
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