CONVENIENT CARE CLINIC LLC NPI 1851490841

NPI Information

  • NPI: 1851490841
  • Provider Name: CONVENIENT CARE CLINIC, LLC
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Organization
  • CLIA Number: 25D0316341
  • Address: 3040 GOODMAN RD WEST
    HORN LAKE, MS
    ZIP 38637
  • Phone: (662) 578-2030

Map and Directions

Get Directions

NPI Details

CONVENIENT CARE CLINIC, LLC is a family nurse practitioner in Horn Lake, MS. CONVENIENT CARE CLINIC, LLC NPI is 1851490841. The provider is registered as an organization entity type.

The provider's business location address is:

3040 GOODMAN RD WEST
HORN LAKE, MS
ZIP 38637-474
Phone: (662) 578-2030
Fax: (615) 301-6550

The provider's authorized official is Stephanie Hicks .
The authorized official title is Controller and has the following contact phone number (615) 988-2004.

The CLIA number assigned to this NPI record is 25D0316341 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/22/2006 and was last updated on 8/4/2025.

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
1261QR1300XClinic/CenterRural HealthNo
2363LF0000XNurse 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
109015109MEDICAIDMISSISSIPPI

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

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

Previous NPI
Next NPI