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General NPI Number Information
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NPI Number | 1215849948
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Entity Type | Organization
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Legal Business Name | PISGAH COMMUNITY CARE PROVIDERS PLLC
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Dates
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Enumeration Date | 09/18/2026
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Last Update Date | 09/18/2026
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Provider Practice Location Address
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Address Line | 3946 HIGHWAY 43 NORTH
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City | BRANDON
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State | MS
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Zip | 39047
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Country | US
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Telephone | 662-607-3163
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Fax |
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Provider Business Mailing Address
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Address Line | 160 GOSHEN SPRINGS LN
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City | BRANDON
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State | MS
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Zip | 39047-7246
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Country | US
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Telephone | 662-607-3163
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Fax | 601-741-9155
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ANGELA GRAHAM
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Credential | NURSE PRACTITIONER
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Telephone | 601-540-8658
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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