AMBER RENEE AYLESWORTH, AGNP — NPI 1780358192 (Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology in PEARL, MS)

CMS-1500 Box 24J / 33a • NPI

1780358192

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

363LG0600X (CMS 50)

Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology

Box 32 Service Location & ZIP+4

3654 HOOD DR, PEARL, MS, 39208-3805

✓ 9-Digit EDI 837 ZIP+4 (39208-3805)

Practice Phone & Referral Fax

(662) 571-8731

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1780358192 (AMBER RENEE AYLESWORTH, AGNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1780358192` (NPI-1 Individual Practitioner)
Provider / Legal Name	AMBER RENEE AYLESWORTH, AGNP
Plain-English Specialty	Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology NUCC Code: `363LG0600X` (Nurse Practitioner, Gerontology)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	3654 HOOD DR, PEARL, MS, 39208-3805
Practice Telephone / Fax	Tel: (662) 571-8731
Administrative Mailing Address	3654 HOOD DR, PEARL, MS, 39208-3805
Enumeration & Last Sync	Enumerated: 2021-08-09 \| CMS Record Updated: 2021-08-09

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

3654 HOOD DR, PEARL, MS, 39208-3805

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Plain-English Taxonomy & CMS Crosswalk (363LG0600X)

What Does Taxonomy Code 363LG0600X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LG0600X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 50 (Nurse Practitioner)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Nurse Practitioner, Gerontology for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (AMBER RENEE AYLESWORTH, AGNP)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`363LG0600X` — Nurse Practitioner, Gerontology Plain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Gerontology	State: MS \| License: `2021036268.` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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AMBER RENEE AYLESWORTH, AGNP (NPI #1780358192)