Organization
HEALTHY LIVING FAMILY MEDICAL CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WYCONDAROGA E THOMAS FNP-C (NURSE PRACTITIONER/OWNER)
(662) 402-0174
Entity
Organization
Contact information
Practice address
820 ASHLAND AVENUE, GUNNISION, MS 38746
(662) 987-5023
(662) 987-5025
Mailing address
PO BOX 357, GUNNISON, MS 38746-0357
(662) 987-5023
(662) 987-5025
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
363LF0000X
Family Nurse Practitioner
890243
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04784050
—
MS
Enumeration date
08/03/2017
Last updated
02/03/2023
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