Healthcare Provider Details

I. General information

NPI: 1104383389
Provider Name (Legal Business Name): PREMIER FAMILY AND URGENT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 08/31/2020
Certification Date: 08/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2394 MCCULLOUGH BLVD
BELDEN MS
38826-9579
US

IV. Provider business mailing address

2394 MCCULLOUGH BLVD
BELDEN MS
38826-9579
US

V. Phone/Fax

Practice location:
  • Phone: 622-053-0236
  • Fax: 844-465-9102
Mailing address:
  • Phone: 662-269-1774
  • Fax: 844-465-9102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JESSICA HICKS-ROBERTSON
Title or Position: OWNER
Credential: FNP
Phone: 662-840-4577