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General NPI Number Information
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NPI Number | 1922818467
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Entity Type | Organization
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Legal Business Name | HEC MEDICAL
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 6858 SWINNEA RD BLDG 7
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9493
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Country | US
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Telephone | 662-536-6210
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Fax | 228-227-4099
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Provider Business Mailing Address
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Address Line | 6858 SWINNEA RD BLDG 7
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City | SOUTHAVEN
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State | MS
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Zip | 38671-9493
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Country | US
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Telephone | 662-536-6210
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Fax | 228-227-4099
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Authorized Official
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Title or Position | CEO
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Name | CARRIE ANN CARR
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Credential | LCPC
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Telephone | 662-536-6210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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