| Kidz 1st Clinic, Llc | |
|
321 E Fifteenth St Yazoo City MS 39194-2631 | |
| (662) 532-1543 | |
| Not Available |
| Full Name | Kidz 1st Clinic, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 321 E Fifteenth St, Yazoo City, Mississippi |
| Authorized Official Name and Position | Tiffany Allison Bowen (OWNER) |
| Authorized Official Contact | 6625321543 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kidz 1st Clinic, Llc 321 E Fifteenth St Yazoo City MS 39194-2631 Ph: (662) 532-1543 | Kidz 1st Clinic, Llc 321 E Fifteenth St Yazoo City MS 39194-2631 Ph: (662) 532-1543 |
| NPI Number | 1083265284 |
|---|---|
| Provider Enumeration Date | 09/27/2019 |
| Last Update Date | 05/31/2022 |
| Medicare PECOS PAC ID | 6103253570 |
|---|---|
| Medicare Enrollment ID | O20200225000072 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083265284 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| 363LP0200X | Nurse Practitioner - Pediatrics | (* (Not Available)) | Secondary |
| Provider Name | Tiffany Allison Bowen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073533782 PECOS PAC ID: 7012344492 Enrollment ID: I20200225000104 |
| Provider Name | Anna Laura Clark Scroggins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497382121 PECOS PAC ID: 5395176515 Enrollment ID: I20200504000290 |
| Provider Name | Shelly Kimberlyn Sarrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1386392298 PECOS PAC ID: 7517344880 Enrollment ID: I20220509000007 |
| Provider Name | Michaela F Stone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1003515578 PECOS PAC ID: 2567836257 Enrollment ID: I20230320002701 |
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