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General NPI Number Information
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NPI Number | 1184120883
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Entity Type | Organization
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Legal Business Name | LENA FAMILY MEDICAL, INC.
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Dates
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Enumeration Date | 04/02/2018
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Last Update Date | 03/04/2021
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Provider Practice Location Address
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Address Line | 1107 GRAND AVENUE
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City | LENA
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State | MS
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Zip | 39094
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Country | US
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Telephone | 601-654-3433
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Fax | 601-654-0117
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Provider Business Mailing Address
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Address Line | 1107 GRAND AVENUE P.O. BOX 295
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City | LENA
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State | MS
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Zip | 39094
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Country | US
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Telephone | 601-654-3433
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Fax | 601-654-0117
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | REBECCA ANNETTE JOHNSTON
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Credential | FNP-C
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Telephone | 601-654-3433
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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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