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General NPI Number Information
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NPI Number | 1699223743
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Entity Type | Organization
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Legal Business Name | MERCY FAMILY MEDICAL CLINIC
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Dates
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Enumeration Date | 09/19/2016
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Last Update Date | 09/19/2016
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Provider Practice Location Address
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Address Line | 1306 HARDY ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-4981
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Country | US
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Telephone | 601-508-5264
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Fax |
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Provider Business Mailing Address
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Address Line | 1306 HARDY ST
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City | HATTIESBURG
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State | MS
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Zip | 39401-4981
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Country | US
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Telephone | 601-508-5264
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. MICHELE F. MCLEOD
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Credential | FNP
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Telephone | 601-508-5264
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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 | 645982
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License Number State | MS
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