Healthcare Provider Details

I. General information

NPI: 1023213550
Provider Name (Legal Business Name): FAMILY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 02/11/2026
Certification Date: 02/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 MORRIS ST
MOSS POINT MS
39563-2838
US

IV. Provider business mailing address

4730 MORRIS ST
MOSS POINT MS
39563-2838
US

V. Phone/Fax

Practice location:
  • Phone: 228-285-0361
  • Fax:
Mailing address:
  • Phone: 228-285-0361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11452
License Number StateMS

VIII. Authorized Official

Name: KENDRA S GARDNER
Title or Position: OWNER
Credential: NP
Phone: 228-285-0361