MEDICARE: KINGDOM COVENANT CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider
2	3747P1801X	Personal Care Attendant

General Provider Information

NPI Number	:	1073477212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINGDOM COVENANT CARE, LLC

Provider Business Mailing Address
First Line	:	3512 FOREST HILL RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3819
Country	:	US
Telephone Number	:	601-213-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	3512 FOREST HILL RD
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39212-3819
Country	:	US
Telephone Number	:	601-213-7010
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ALISHA WHITE
Credential	:
Telephone Number	:	601-213-7010

Provider Enumeration Date	:	12/11/2025
Last Update Date	:	05/14/2026

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Directions to “KINGDOM COVENANT CARE, LLC ” Practice Location

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