| Pivotal Health And Wellness Clinic, Llc | |
|
110 Cross Park Dr Ste A Pearl MS 39208-9016 | |
| (601) 278-3241 | |
| Not Available |
| Full Name | Pivotal Health And Wellness Clinic, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 110 Cross Park Dr Ste A, Pearl, Mississippi |
| Authorized Official Name and Position | Grenisha Young (FAMILY NURSE PRACTITIONER) |
| Authorized Official Contact | 6012783241 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pivotal Health And Wellness Clinic, Llc Po Box 4244 Brandon MS 39047-4244 Ph: () - | Pivotal Health And Wellness Clinic, Llc 110 Cross Park Dr Ste A Pearl MS 39208-9016 Ph: (601) 278-3241 |
| NPI Number | 1700533890 |
|---|---|
| Provider Enumeration Date | 03/08/2022 |
| Last Update Date | 03/08/2022 |
| Medicare PECOS PAC ID | 2264819101 |
|---|---|
| Medicare Enrollment ID | O20220516002361 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700533890 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Grenisha Young |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023503554 PECOS PAC ID: 9931447877 Enrollment ID: I20190219001043 |
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