| Picayune Rural Health Clinic | |
|
317 N Main St Picayune MS 39466-3313 | |
| (601) 799-5577 | |
| (601) 799-5444 |
| Full Name | Picayune Rural Health Clinic |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 317 N Main St, Picayune, Mississippi |
| Authorized Official Name and Position | Krista Kay Hodge (OWNER) |
| Authorized Official Contact | 6017995577 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Picayune Rural Health Clinic 317 N Main St Picayune MS 39466-3313 Ph: (601) 799-5577 | Picayune Rural Health Clinic 317 N Main St Picayune MS 39466-3313 Ph: (601) 799-5577 |
| NPI Number | 1700983913 |
|---|---|
| Provider Enumeration Date | 09/20/2006 |
| Last Update Date | 08/18/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700983913 | NPI | - | NPPES |
| 09045721 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 13678 (Mississippi) | Secondary |
| 363L00000X | Nurse Practitioner | R767181 (Mississippi) | Primary |
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