Healthcare Provider Details

I. General information

NPI: 1366358160
Provider Name (Legal Business Name): ABUNDANT CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 KIRKWOOD DR
CLINTON MS
39056-5975
US

IV. Provider business mailing address

130 KIRKWOOD DR
CLINTON MS
39056-5975
US

V. Phone/Fax

Practice location:
  • Phone: 601-910-9217
  • Fax:
Mailing address:
  • Phone: 601-910-9217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SOPHILA TUCKER
Title or Position: OWNER
Credential:
Phone: 601-497-2017