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General NPI Number Information
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NPI Number | 1437503513
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Entity Type | Organization
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Legal Business Name | PREMIER CHOICE HEALTHCARE AND EDUCATIONAL SERVICES
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Dates
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Enumeration Date | 04/14/2016
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 1832 HOSPITAL DR
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City | JACKSON
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State | MS
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Zip | 39204-3410
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Country | US
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Telephone | 214-620-4927
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 820472
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City | VICKSBURG
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State | MS
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Zip | 39182-0472
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Country | US
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Telephone | 214-620-4927
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MR. CHRISTOPHER ALAN CARSON
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Credential | FNP-C
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Telephone | 214-620-5860
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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 | 880514
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License Number State | MS
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