Organization
THE RAINBOW CHILDREN'S CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PORTIA F TRAVIS CFNP (NURSE PRACTITIONER)
(662) 751-8566
Entity
Organization
Contact information
Practice address
730 E FIFTEENTH ST, YAZOO CITY, MS 39194-2706
(662) 751-8566
Mailing address
730 E FIFTEENTH ST, YAZOO CITY, MS 39194-2706
(662) 751-8566
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R800172
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08227546
—
MS
Enumeration date
06/18/2008
Last updated
06/18/2008
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