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General NPI Number Information
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NPI Number | 1164757142
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Entity Type | Organization
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Legal Business Name | CLAIBORNE COUNTY SCHOOL
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Dates
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Enumeration Date | 10/09/2009
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Last Update Date | 10/09/2009
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Provider Practice Location Address
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Address Line | 161 RAMSEY DR
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City | PORT GIBSON
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State | MS
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Zip | 39150-2531
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Country | US
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Telephone | 601-437-4251
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Fax |
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Provider Business Mailing Address
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Address Line | 404 MARKET ST
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City | PORT GIBSON
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State | MS
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Zip | 39150-2025
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Country | US
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Telephone | 601-437-4232
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Fax |
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Authorized Official
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Title or Position | SUPERINTENDENT OF EDUCATION
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Name | DR. ANNIE KILCREASE
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Credential | PH D
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Telephone | 601-437-4232
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number | 02382394
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License Number State | MS
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