Healthcare Provider Details

I. General information

NPI: 1104662279
Provider Name (Legal Business Name): VITA TEMPUS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 FAIRMONT ST STE C
CLINTON MS
39056-4739
US

IV. Provider business mailing address

134 FAIRMONT ST STE C
CLINTON MS
39056-4739
US

V. Phone/Fax

Practice location:
  • Phone: 769-348-3330
  • Fax: 769-348-3351
Mailing address:
  • Phone: 769-348-3330
  • Fax: 769-348-3351

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: MRS. PRINCE S MCCLINTON
Title or Position: CO-OWNER/FNP
Credential: NP
Phone: 769-348-3330