OrganizationActive
Ageless Men'S Health, LLC
NPI 1124322474 · Family Nurse Practitioner · Southaven, MS
Provider details
- NPI number
- 1124322474
- Entity type
- Organization
- Primary specialty
- Family Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Amanda Wilkinson, Business Operations Director(702) 818-0446
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Profile Score
Detailed profile(82/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
15 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
7111 Southcrest Pkwy
Suite 109
Southaven, MS 38671-4850
Phone: (901) 522-6745
Fax: (901) 522-6748
Street-level locationGet directions
Mailing address
7111 Southcrest Pkwy
Southaven, MS 38671-4850
Registry dates
- Enumerated
- 2010-12-30
- Last updated
- 2024-11-11
- Certified
- 2024-11-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.