| NPI | 1629741152 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | REKITA D. MCCOY CEO 601-345-4044 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| Enumeration Date | 2021-07-29 |
| Last Update Date | 2022-09-03 |