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General NPI Number Information
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NPI Number | 1174279301
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Entity Type | Organization
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Legal Business Name | FAMILY CARE CENTER LLC
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Dates
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Enumeration Date | 02/25/2022
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Last Update Date | 05/23/2022
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Provider Practice Location Address
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Address Line | 4730 MORRIS ST
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City | MOSS POINT
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State | MS
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Zip | 39563-2838
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Country | US
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Telephone | 228-285-0361
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Fax |
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Provider Business Mailing Address
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Address Line | 4730 MORRIS ST
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City | MOSS POINT
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State | MS
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Zip | 39563-2838
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Country | US
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Telephone | 228-285-0361
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENDRA S GARDNER
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Credential | NP
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Telephone | 760-443-4616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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