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General NPI Number Information
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NPI Number | 1053646190
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Entity Type | Organization
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Legal Business Name | MORE CONVENIENT CARE CENTER LLC
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Dates
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Enumeration Date | 10/07/2009
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 4612 MEDGAR EVERS BLVD SUITE 10
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City | JACKSON
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State | MS
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Zip | 39213-5205
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Country | US
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Telephone | 601-321-9104
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Fax | 601-321-9138
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Provider Business Mailing Address
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Address Line | P. O. BOX 68483
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City | JACKSON
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State | MS
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Zip | 39286
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Country | US
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Telephone | 601-321-9104
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Fax | 601-321-9138
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. MARY LYNN HILLIARD
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Credential | APRN, BC, FNP
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Telephone | 601-209-8432
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | R656046
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License Number State | MS
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