Healthcare Provider Details

I. General information

NPI: 1306977848
Provider Name (Legal Business Name): MEDICAL FOUNDATION, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 01/17/2025
Certification Date: 01/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 14TH ST
MERIDIAN MS
39301-4140
US

IV. Provider business mailing address

DEPT 3020, PO BOX 1000
MEMPHIS TN
38148-3020
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-4415
  • Fax: 601-703-4418
Mailing address:
  • Phone: 601-213-3010
  • Fax: 601-213-3011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DON LARKIN KENNEDY
Title or Position: REGIONAL CEO
Credential:
Phone: 601-703-9614