Healthcare Provider Details

I. General information

NPI: 1669299855
Provider Name (Legal Business Name): PRIDE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2024
Last Update Date: 07/20/2025
Certification Date: 07/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

456 HIGHWAY 6 E
BATESVILLE MS
38606-3000
US

IV. Provider business mailing address

456 HIGHWAY 6 E
BATESVILLE MS
38606-3000
US

V. Phone/Fax

Practice location:
  • Phone: 682-233-4155
  • Fax: 662-214-6098
Mailing address:
  • Phone: 662-614-7606
  • Fax: 662-214-6087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LEKISHA PRIDE
Title or Position: OWNER
Credential: APRN-CNP
Phone: 662-614-7606