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General NPI Number Information
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NPI Number | 1275321754
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Entity Type | Organization
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Legal Business Name | BROOKHAVEN DIABETES AND PRIMARY CARE CLINIC
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Dates
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Enumeration Date | 04/25/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 317 JAKES TRL NW
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City | BROOKHAVEN
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State | MS
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Zip | 39601-8632
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Country | US
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Telephone | 601-320-1246
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Fax |
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Provider Business Mailing Address
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Address Line | 317 JAKES TRL NW
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City | BROOKHAVEN
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State | MS
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Zip | 39601-8632
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Country | US
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Telephone | 601-265-2018
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Fax | 949-864-3748
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Authorized Official
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Title or Position | OWNER
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Name | AMY KATHERYN CASE
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Credential | CFNP, ADM
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Telephone | 601-265-2018
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WD0400X
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Taxonomy Name | Diabetes Educator Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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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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