PUCKETT FAMILY MEDICAL CLINIC NPI 1689285249

NPI Information

NPI: 1689285249
Provider Name: PUCKETT FAMILY MEDICAL CLINIC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
6455 HIGHWAY 18
BRANDON, MS
ZIP 39042
Phone: (601) 824-9490
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PUCKETT FAMILY MEDICAL CLINIC is a family nurse practitioner in Brandon, MS. PUCKETT FAMILY MEDICAL CLINIC NPI is 1689285249. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

6455 HIGHWAY 18
BRANDON, MS
ZIP 39042-536
Phone: (601) 824-9490
Fax: (601) 824-5855

The provider's authorized official is Ashely M Shivers .
The authorized official title is Owner and has the following contact phone number (601) 824-9490.

The enumeration date for this NPI number is 8/16/2020 and was last updated on 8/16/2020.

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
1	363LF0000X	Nurse Practitioner	Family			Yes

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: 4/28/2024

NPI Synchronization or Removal

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