institution
Divinity Pediatric Clinic, Pllc
Pediatric Nurse Practitioner in Pearl, Mississippi
NPI 1629741152

Divinity Pediatric Clinic, Pllc is a Pediatric Nurse Practitioner based in Brandon, MS and is specialized in Pediatrics. Divinity Pediatric Clinic, Pllc practices in Pearl, MS. The NPI Number for Divinity Pediatric Clinic, Pllc is 1629741152 and holds a License No. (Mississippi).

The current practice location address for Divinity Pediatric Clinic, Pllc is 200 Riverwind Dr Ste 104, Pearl, MS and can be reached out via phone at 601-345-4044 and via fax at 601-510-9334.

Location: 200 Riverwind Dr Ste 104, Pearl, MS, 39042-8482
institution
Provider Profile Details
NPI Number
1629741152
Provider Name
Divinity Pediatric Clinic, Pllc
Credential
Provider Entity Type
Organization
Address
200 Riverwind Dr Ste 104, Pearl, MS, 39042-8482
Phone Number
601-345-4044
Fax Number
601-510-9334
Provider Enumeration Date
07/29/2021
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1629741152 05 MS
institution
Provider Business Practice Location Address Details
Address
200 Riverwind Dr Ste 104
City
State
Zip
39208-5652
Phone Number
601-345-4044
Fax Number
601-510-9334
person
Provider Business Mailing Address Details
Address
200 Riverwind Dr Ste 104
City
State
Zip
39208-5652
Phone Number
601-345-4044
Fax Number
601-510-9334
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Primary Care
Taxonomy
License No.
()
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Pediatrics
Taxonomy
License No.
()
Definition
Definition to come...
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