Healthcare Provider Details

I. General information

NPI: 1134835804
Provider Name (Legal Business Name): NNC SERVICES LLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2023
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N BURKE AVE
LONG BEACH MS
39560-4605
US

IV. Provider business mailing address

100 N BURKE AVE
LONG BEACH MS
39560-4605
US

V. Phone/Fax

Practice location:
  • Phone: 228-234-1658
  • Fax: 228-234-1658
Mailing address:
  • Phone: 228-234-1658
  • Fax: 228-234-1658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. NICOLE CLARK
Title or Position: OWNER/STYLIST
Credential: CRANIAL PROTHESIS
Phone: 228-234-1658