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General NPI Number Information
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NPI Number | 1669805297
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Entity Type | Organization
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Legal Business Name | PRIORITY MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 08/07/2023
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Provider Practice Location Address
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Address Line | 601 N 15TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-3839
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Country | US
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Telephone | 601-323-1920
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Fax | 855-452-4557
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Provider Business Mailing Address
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Address Line | 601 N 15TH AVE
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City | LAUREL
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State | MS
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Zip | 39440-3839
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Country | US
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Telephone | 601-651-6362
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Fax | 855-452-4557
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Authorized Official
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Title or Position | OWNER
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Name | LINDY N COCHRAN
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Credential | F.N.P
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Telephone | 601-651-6362
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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 | R865733
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License Number State | MS
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