Healthcare Provider Details

I. General information

NPI: 1578776647
Provider Name (Legal Business Name): AMITE COUNTY SCHOOL DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

154 RAILROAD AND CASSELS
GLOSTER MS
39638
US

IV. Provider business mailing address

PO BOX 378
LIBERTY MS
39645-0378
US

V. Phone/Fax

Practice location:
  • Phone: 601-225-4046
  • Fax: 601-225-4046
Mailing address:
  • Phone: 601-657-4361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberR635294
License Number StateMS

VIII. Authorized Official

Name: MR. CHARLES E. KIRKFIELD
Title or Position: SUPERINTENDENT OF EDUCATION
Credential:
Phone: 601-657-4361