Healthcare Provider Details

I. General information

NPI: 1740412287
Provider Name (Legal Business Name): OXFORD FAMILY CLINIC,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2009
Last Update Date: 03/15/2021
Certification Date: 03/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1109 N LAMAR BLVD SUITE 1
OXFORD MS
38655-2861
US

IV. Provider business mailing address

1914 UNIVERSITY AVE
OXFORD MS
38655-4114
US

V. Phone/Fax

Practice location:
  • Phone: 662-238-7860
  • Fax: 662-238-7871
Mailing address:
  • Phone: 662-238-7860
  • Fax: 662-238-7871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR857620
License Number StateMS

VIII. Authorized Official

Name: MICHELLE CULLEN
Title or Position: FNP
Credential:
Phone: 662-238-7860