Healthcare Provider Details

I. General information

NPI: 1306966502
Provider Name (Legal Business Name): COURT SQUARE RURAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 EAST COURT ST.
SUMNER MS
38957
US

IV. Provider business mailing address

406 EAST COURT STREET
SUMNER MS
38957
US

V. Phone/Fax

Practice location:
  • Phone: 662-375-7717
  • Fax: 662-375-7719
Mailing address:
  • Phone: 662-375-7717
  • Fax: 662-375-7719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. KIMLLBERLY FLETCHER SIMS
Title or Position: PARTNER
Credential: LPN
Phone: 662-375-7717