Healthcare Provider Details

I. General information

NPI: 1801528591
Provider Name (Legal Business Name): ULTIMATE CARE MEDICAL CLINIC PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2022
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 STARK RD
STARKVILLE MS
39759-3613
US

IV. Provider business mailing address

900 STARK RD
STARKVILLE MS
39759-3613
US

V. Phone/Fax

Practice location:
  • Phone: 662-694-2420
  • Fax:
Mailing address:
  • Phone: 662-694-2420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: RUSHAUNDA NASH
Title or Position: OWNER
Credential: FNP
Phone: 662-694-2420