# CASSIDY BAYOU MEDICAL CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376181990
- **Authorized official:** SONJA BUSH PENNINGTON FNP (PROVIDER/OWNER)
- **Authorized official phone:** (662) 375-2363

## Contact information

- **Practice address:** 2372 US 49-E, SUMNER, MS 38957
- **Practice address phone:** (662) 375-9310
- **Mailing address:** PO BOX 240, SUMNER, MS 38957-0240
- **Mailing address phone:** (662) 375-9310
- **Mailing address fax:** (662) 375-9311

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/13/2019
- **Last updated:** 04/27/2020