Organization
KIDZ 1ST CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIFFANY ALLISON BOWEN CPNP-PC (OWNER)
(662) 532-1543
Entity
Organization
Contact information
Practice address
321 E FIFTEENTH ST, YAZOO CITY, MS 39194-2631
(662) 532-1543
Mailing address
321 E FIFTEENTH ST, YAZOO CITY, MS 39194-2631
(662) 532-1543
(662) 532-1544
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363LP0200X
Pediatric Nurse Practitioner
—
—
Other
Enumeration date
09/27/2019
Last updated
05/31/2022
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