Organization
EVERYCARE EXPRESS CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE JACKSON FNP-BC (NURSE PRACTITIONER)
(601) 859-0140
Entity
Organization
Contact information
Practice address
162 FEATHER LN, SUITE E, CANTON, MS 39046-8510
(601) 859-0140
Mailing address
PO BOX 417, MADISON, MS 39130-0417
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
R862558
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00780035
—
MS
Enumeration date
10/30/2014
Last updated
12/31/2014
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