Healthcare Provider Details

I. General information

NPI: 1043386642
Provider Name (Legal Business Name): FAMILY CARE CLINIC OF RIPLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/27/2006
Last Update Date: 06/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1007 N MAIN ST
RIPLEY MS
38663-1424
US

IV. Provider business mailing address

PO BOX 4027
TUPELO MS
38803-4027
US

V. Phone/Fax

Practice location:
  • Phone: 662-993-9336
  • Fax: 662-993-9338
Mailing address:
  • Phone: 662-993-9336
  • Fax: 662-993-9338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: WANDA STROUPE
Title or Position: NURSE PRACTITIONER
Credential:
Phone: 662-993-9336