Organization
HICKORY FLAT CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE THOMPSON FNP (FNP)
(662) 551-6492
Entity
Organization
Contact information
Practice address
250 OAK ST, HICKORY FLAT, MS 38633
(662) 551-6492
Mailing address
6492 BECK SPRINGS RD, HICKORY FLAT, MS 38633-9116
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
R855906
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09426886
—
MS
Enumeration date
03/20/2013
Last updated
03/20/2013
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