| Healthyconnect Primary Care Of Mississippi Llc | |
|
1880 Lakeland Dr Ste E Jackson MS 39216-4916 | |
| (601) 914-2109 | |
| Not Available |
| Full Name | Healthyconnect Primary Care Of Mississippi Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1880 Lakeland Dr Ste E, Jackson, Mississippi |
| Authorized Official Name and Position | Fred Burris (CFO) |
| Authorized Official Contact | 8133347442 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Healthyconnect Primary Care Of Mississippi Llc 1880 Lakeland Dr Ste E Jackson MS 39216-4916 Ph: () - | Healthyconnect Primary Care Of Mississippi Llc 1880 Lakeland Dr Ste E Jackson MS 39216-4916 Ph: (601) 914-2109 |
| NPI Number | 1770324659 |
|---|---|
| Provider Enumeration Date | 06/04/2024 |
| Last Update Date | 08/28/2024 |
| Medicare PECOS PAC ID | 3779014303 |
|---|---|
| Medicare Enrollment ID | O20241007001094 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770324659 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Kimberly L Campbell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770221640 PECOS PAC ID: 5890168579 Enrollment ID: I20230228000515 |
| Provider Name | Wendy Hughes |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518035377 PECOS PAC ID: 9032119375 Enrollment ID: I20241008003659 |
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