Healthcare Provider Details

I. General information

NPI: 1326954736
Provider Name (Legal Business Name): SCALLION FAMILY MEDICAL CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N MAIN ST
DREW MS
38737-3406
US

IV. Provider business mailing address

PO BOX 243
DREW MS
38737-0243
US

V. Phone/Fax

Practice location:
  • Phone: 662-649-6045
  • Fax: 949-875-6984
Mailing address:
  • Phone: 662-649-6045
  • Fax: 949-875-6984

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: BROOKE SCALLION
Title or Position: OWNER
Credential: FNP-C
Phone: 662-649-6045