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General NPI Number Information
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NPI Number | 1770391070
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Entity Type | Organization
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Legal Business Name | ELITE CARE FAMILY PRACTICE CLINIC LLC
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Dates
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Enumeration Date | 12/19/2024
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 314 S 25TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7301
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Country | US
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Telephone | 601-255-8808
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Fax | 866-531-8054
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Provider Business Mailing Address
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Address Line | 314 S 25TH AVE
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City | HATTIESBURG
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State | MS
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Zip | 39401-7301
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Country | US
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Telephone | 601-255-8808
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Fax | 601-255-8811
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Authorized Official
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Title or Position | CO OWNER/NP
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Name | PILAR LYAS
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Credential | NP
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Telephone | 601-467-0542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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