Organization
PINE RIDGE FAMILY CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARLANA P. HEDGEPETH FNP (OWNER)
(601) 765-6834
Entity
Organization
Contact information
Practice address
3248 HIGHWAY 49, COLLINS, MS 39428
(601) 800-8580
(601) 800-8583
Mailing address
PO BOX 177, ELLISVILLE, MS 39437-0177
(601) 765-6834
(601) 765-6837
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02053312
—
MS
Enumeration date
02/19/2020
Last updated
07/13/2020
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