EVERGREEN CLINI NPI 1396763298

NPI Information

  • NPI: 1396763298
  • Provider Name: EVERGREEN CLINI
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • Address: 4929 HIGHWAY 371 S
    NETTLETON, MS
    ZIP 38858
  • Phone: (662) 963-9154

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NPI Details

EVERGREEN CLINI is a family nurse practitioner in Nettleton, MS. EVERGREEN CLINI NPI is 1396763298. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

4929 HIGHWAY 371 S
NETTLETON, MS
ZIP 38858-901
Phone: (662) 963-9154
Fax: (662) 963-9157

The provider's authorized official is Jerry Stevens .
The authorized official title is Administration and has the following contact phone number (662) 963-9154.

The enumeration date for this NPI number is 7/18/2006 and was last updated on 8/22/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamilyYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
109013494MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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