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General NPI Number Information
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NPI Number | 1710545488
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Entity Type | Organization
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Legal Business Name | PRIMARY AND BEHAVIORAL HEALTHCARE SERVICES, PA
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Dates
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Enumeration Date | 05/29/2019
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 717 E. FORTIFICATION ST.
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City | JACKSON
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State | MS
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Zip | 39202-2402
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Country | US
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Telephone | 769-572-4009
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Fax | 769-572-4021
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Provider Business Mailing Address
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Address Line | 717 E. FORTIFICATION ST.
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City | JACKSON
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State | MS
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Zip | 39202-2402
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Country | US
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Telephone | 769-572-4009
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Fax | 769-572-4021
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | SHAMECA L HUDSON
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Credential | DNP, FNP-BC
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Telephone | 769-572-4009
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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