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General NPI Number Information
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NPI Number | 1972617876
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Entity Type | Organization
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Legal Business Name | LEXINGTON PRIMARY CARE
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 110 TCHULA STREET LEXINGTON PRIMARY CARE
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City | LEXINGTON
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State | MS
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Zip | 39095
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Country | US
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Telephone | 662-834-1855
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Fax | 662-834-4953
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Provider Business Mailing Address
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Address Line | PO BOX 249
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City | LEXINGTON
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State | MS
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Zip | 39095-0249
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Country | US
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Telephone | 662-834-1855
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Fax | 662-834-4953
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. PAULINE HATHCOCK
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Credential | FNP
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Telephone | 662-834-1855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | R851692
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License Number State | MS
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