Healthcare Provider Details

I. General information

NPI: 1952305815
Provider Name (Legal Business Name): HICKORY FLAT CLINIC ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 OAK ST
HICKORY FLAT MS
38633-8122
US

IV. Provider business mailing address

PO BOX 128
HICKORY FLAT MS
38633-0128
US

V. Phone/Fax

Practice location:
  • Phone: 662-333-6387
  • Fax: 662-333-6725
Mailing address:
  • Phone: 662-333-6387
  • Fax: 662-333-6725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SUE MORRISSON
Title or Position: CLINIC DIRECTOR
Credential: CFNP
Phone: 662-333-6387