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General NPI Number Information
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NPI Number | 1154110575
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Entity Type | Organization
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Legal Business Name | TIPLERSVILLE FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 05/02/2025
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Last Update Date | 05/02/2025
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Provider Practice Location Address
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Address Line | 24111 HIGHWAY 15
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City | TIPLERSVILLE
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State | MS
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Zip | 38674
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Country | US
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Telephone | 662-672-7527
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Fax |
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Provider Business Mailing Address
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Address Line | 2820 COUNTY ROAD 301
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City | FALKNER
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State | MS
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Zip | 38629-9321
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Country | US
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Telephone | 662-882-3635
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | CANDICE HEAVENER
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Credential | NP
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Telephone | 662-672-7527
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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 |
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License Number State |
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