| Divinity Healthcare Inc | |
|
Space #99 Unit K, Winchester Drive West Point MS 39773-3974 | |
| (662) 848-3656 | |
| Not Available |
| Full Name | Divinity Healthcare Inc |
|---|---|
| Speciality | Nurse Practitioner - Family |
| Location | Space #99 Unit K, Winchester Drive, West Point, Mississippi |
| Authorized Official Name and Position | Trinity Sharda Johnson (OWNER) |
| Authorized Official Contact | 6628483656 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Divinity Healthcare Inc 55 Dwelling Pl Caledonia MS 39740-1011 Ph: (662) 848-3656 | Divinity Healthcare Inc Space #99 Unit K, Winchester Drive West Point MS 39773-3974 Ph: (662) 848-3656 |
| NPI Number | 1396567301 |
|---|---|
| Provider Enumeration Date | 10/30/2024 |
| Last Update Date | 11/08/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396567301 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
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