KIDS FIRST PEDIATRIC CLINIC, LLC (NPI# 1356701783) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356701783 |
| Entity Type | Organization |
| Organization Name | KIDS FIRST PEDIATRIC CLINIC, LLC |
| Practice Address |
529 Lake St Ste B Hazlehurst MS 39083-2226 |
| Mailing Address |
Po Box 10671 Jackson MS 39289-0671 |
| Practice Telephone | 6016688400 |
| Mailing Telephone | 6016688400 |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2018-06-20 |
| Authorized Official Name | TIFFANY ROCHELLE JACKSON (FAMILY NURSE PRACTITIONER) |
| Authorized Official Telephone | 6016688400 |
| Authorized Official Credential | FNP |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 364SP0200X |
Clinical Nurse Specialist Specialization: Pediatrics |
R881238 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | KIDS FIRST PEDIATRIC CLINIC, LLC | 18676 Willamette Dr, Suite 300, West Linn, OR 97068 |
| Street Address |
529 LAKE ST STE B |
| City | HAZLEHURST |
| State | MS |
| Zip Code | 39083-2226 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235757949 | Claiborne Brooke White | Speech-Language Pathologist | 27190 Ms-28, Hazlehurst, MS 39083 | 2020-07-09 |
| 1750898961 | Laquita L. Johnson | Pharmacist | 102 Williams Street, Hazlehurst, MS 39083 | 2018-01-09 |
| 1134633324 | Enduracare Acute Care Services LLC | Clinic/Center | 236 North Caldwell Drive, Hazelhurst, MS 39083 | 2017-11-27 |
| 1053852392 | Alvin Dale Griffin | Occupational Therapy Assistant | 27190 Ms 28, Hazlehurst, MS 39083 | 2017-03-20 |
| 1770609364 | Gerri L Hill Chance | Psychiatry & Neurology | 206 Robert Mcdaniel Drive, Hazelhurst, MS 39083 | 2007-03-22 |
| 1902976665 | Allred's Pharmacy Inc | Pharmacy | 214 West Gallatin St, Hazelhurst, MS 39083 | 2006-11-09 |
| 1891897260 | Fred J Mcdonnell | Family Medicine | 213 Caldwell Drive, Hazlehurst, MS 39083 | 2006-09-05 |
| 1770515058 | Central Mississippi Civic Improvement Association | Clinic/Center | 550 Caldwell Drive, Hazlehurst, MS 39083 | 2006-07-07 |
| 1881649168 | Isd Renal Inc | Clinic/Center | 201 N Haley St, Hazlehurst, MS 39083 | 2006-05-24 |
| 1396793188 | Hazlehurst Vision Clinic | Optometrist | 247 North Caldwell Dr., Suite B, Hazlehurst, MS 39083 | 2006-05-04 |
| Find all providers in zip 39083 | ||||
| Taxonomy Code | 364SP0200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Clinical Nurse Specialist |
| Specialization | Pediatrics |
| Definition to come... |
| City | HAZLEHURST |
| Zip Code | 39083 |
Please comment or provide details below to improve the information on KIDS FIRST PEDIATRIC CLINIC, LLC.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.