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Organization
PRIMARY AND BEHAVIORAL HEALTHCARE SERVICES, PA
Active
Organization
PRIMARY AND BEHAVIORAL HEALTHCARE SERVICES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHAMECA L HUDSON DNP, FNP-BC (CHIEF EXECUTIVE OFFICER)
(769) 572-4009
Entity
Organization
Contact information
Practice address
717 E. FORTIFICATION ST., JACKSON, MS 39202-2402
(769) 572-4009
(769) 572-4021
Mailing address
717 E. FORTIFICATION ST., JACKSON, MS 39202-2402
(769) 572-4009
(769) 572-4021
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00000000
—
MS
05
—
005486078
—
MS
05
—
1679135982
—
MS
05
—
1710545488
—
MS
05
—
858885
—
MS
Enumeration date
05/29/2019
Last updated
10/04/2024
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