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General NPI Number Information
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NPI Number | 1306393830
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Entity Type | Organization
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Legal Business Name | THAXTON MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 11/16/2016
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Provider Practice Location Address
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Address Line | 11145 HIGHWAY 6 WEST
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City | THAXTON
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State | MS
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Zip | 38871
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Country | US
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Telephone | 662-489-8500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 99
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City | THAXTON
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State | MS
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Zip | 38871-0099
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Country | US
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Telephone | 662-489-8500
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Fax | 662-489-8600
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Authorized Official
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Title or Position | OWNER/
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Name | MRS. ELIZABETH BROOKE HOOKER
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Credential | RT
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Telephone | 662-489-8500
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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 | R850403
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 901698
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 23667
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License Number State | MS
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