Healthcare Provider Details

I. General information

NPI: 1891634879
Provider Name (Legal Business Name): WHITECREST CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 BOULEVARD ST
LEXINGTON MS
39095-3529
US

IV. Provider business mailing address

104 BOULEVARD ST
LEXINGTON MS
39095-3529
US

V. Phone/Fax

Practice location:
  • Phone: 601-624-5912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LILY GUACSTELLA
Title or Position: OWNER
Credential: MD
Phone: 601-624-5912