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General NPI Number Information
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NPI Number | 1730829060
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Entity Type | Organization
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Legal Business Name | WARE FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 04/01/2022
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | 972 COLUMBIA AVE
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City | PRENTISS
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State | MS
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Zip | 39474-5405
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Country | US
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Telephone | 601-792-5343
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2275
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City | PRENTISS
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State | MS
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Zip | 39474-2275
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Country | US
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Telephone | 601-792-5343
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Fax | 601-792-5345
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Authorized Official
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Title or Position | OWNER
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Name | ASHLEY KIRBY WARE
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Credential | NURSE PRACTITIONER
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Telephone | 601-543-5859
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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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