MEDICARE: EVERYCARE EXPRESS CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center	R862558	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225433436
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVERYCARE EXPRESS CLINIC

Provider Business Mailing Address
First Line	:	PO BOX 417
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39130-0417
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	162 FEATHER LN
Second Line	:	SUITE E
City	:	CANTON
State	:	MS
Zip	:	39046-8510
Country	:	US
Telephone Number	:	601-859-0140
Fax Number	:

Authorized Official
Title or Position	:	NURSE PRACTITIONER
Name	:	STEPHANIE JACKSON
Credential	:	FNP-BC
Telephone Number	:	601-859-0140

Provider Enumeration Date	:	10/30/2014
Last Update Date	:	12/31/2014

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Directions to “EVERYCARE EXPRESS CLINIC ” Practice Location

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