| Mays Medical Wellness, Llc | |
|
3964 Goodman Rd E Ste 128 Southaven MS 38672-6494 | |
| (662) 655-0456 | |
| (662) 655-0457 |
| Full Name | Mays Medical Wellness, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3964 Goodman Rd E Ste 128, Southaven, Mississippi |
| Authorized Official Name and Position | Tracey L. Mays (FNP) |
| Authorized Official Contact | 6626550456 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mays Medical Wellness, Llc 3964 Goodman Rd E Ste 128 Southaven MS 38672-6494 Ph: (662) 655-0456 | Mays Medical Wellness, Llc 3964 Goodman Rd E Ste 128 Southaven MS 38672-6494 Ph: (662) 655-0456 |
| NPI Number | 1649790437 |
|---|---|
| Provider Enumeration Date | 06/22/2017 |
| Last Update Date | 03/01/2023 |
| Medicare PECOS PAC ID | 6406113299 |
|---|---|
| Medicare Enrollment ID | O20171204001138 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649790437 | NPI | - | NPPES |
| 001870621 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (Mississippi) | Primary |
| 363LP2300X | Nurse Practitioner - Primary Care | (* (Not Available)) | Secondary |
| Provider Name | Tracey L Mays |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1780917443 PECOS PAC ID: 1759421605 Enrollment ID: I20091228000246 |
| Provider Name | Casey L Nester |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578816575 PECOS PAC ID: 2860636016 Enrollment ID: I20130910000462 |
| Provider Name | Penny Marie Holley |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1013524495 PECOS PAC ID: 4082024492 Enrollment ID: I20201112002857 |
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