Healthcare Provider Details

I. General information

NPI: 1679786073
Provider Name (Legal Business Name): WEST UNION CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 08/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1561 HWY 30 WEST
MYRTLE MS
38650
US

IV. Provider business mailing address

1561 HWY 30 WEST
MYRTLE MS
38650
US

V. Phone/Fax

Practice location:
  • Phone: 662-534-0033
  • Fax: 662-539-0039
Mailing address:
  • Phone: 662-534-0033
  • Fax: 662-539-0039

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR860041
License Number StateMS

VIII. Authorized Official

Name: APRIL ROBBINS
Title or Position: OWNER
Credential: FNP
Phone: 662-534-0033