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General NPI Number Information
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NPI Number | 1639973720
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Entity Type | Organization
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Legal Business Name | RENEWED HOPE WELLNESS CLINIC LLC
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Dates
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Enumeration Date | 04/01/2025
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Last Update Date | 04/01/2025
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Provider Practice Location Address
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Address Line | 200 SAINT PAUL ST
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City | PEARL
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State | MS
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Zip | 39208-5134
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Country | US
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Telephone | 601-345-3700
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Fax | 601-345-3750
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Provider Business Mailing Address
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Address Line | 4209 LAKELAND DR # 378
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City | FLOWOOD
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State | MS
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Zip | 39232-9212
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Country | US
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Telephone | 601-209-3300
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Fax | 601-401-4326
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Authorized Official
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Title or Position | FNP-C, PMHNP-BC
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Name | BIANCA BULLIE-THOMPSON
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Credential | DNP
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Telephone | 601-345-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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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 | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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