Healthcare Provider Details

I. General information

NPI: 1073971792
Provider Name (Legal Business Name): CORNER CLINIC URGENT CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 BANK FIRST DR
FLOWOOD MS
39232-6611
US

IV. Provider business mailing address

225 BANK FIRST DR
FLOWOOD MS
39232-6611
US

V. Phone/Fax

Practice location:
  • Phone: 601-992-0004
  • Fax: 769-572-7926
Mailing address:
  • Phone: 601-992-0004
  • Fax: 769-572-7926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License NumberR867447
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR867447
License Number StateMS

VIII. Authorized Official

Name: LESLIE H HOUSTON
Title or Position: MEMBER
Credential: NP-C
Phone: 601-992-0004