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General NPI Number Information
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NPI Number | 1821962440
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Entity Type | Organization
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Legal Business Name | MISSISSIPPI PRIMARY CARE MS
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Dates
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Enumeration Date | 10/06/2025
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Last Update Date | 01/05/2026
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Provider Practice Location Address
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Address Line | 7112 S SIWELL RD STE C
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City | BYRAM
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State | MS
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Zip | 39272-8744
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Country | US
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Telephone | 601-622-5620
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Fax | 601-510-3883
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Provider Business Mailing Address
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Address Line | 7112 S SIWELL RD STE C
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City | BYRAM
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State | MS
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Zip | 39272-8744
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Country | US
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Telephone | 601-622-5620
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Fax | 601-510-3883
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Authorized Official
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Title or Position | NURSE PRACTITIONER/PROVIDER
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Name | CHATINA MARTIN
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Credential | NURSE PRACTITIONER
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Telephone | 601-622-5620
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number |
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License Number State |
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