Organization
HEARTLAND FAMILY MEDICAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TRACY SCOTT FNP (OWNER)
(662) 274-3212
Entity
Organization
Contact information
Practice address
130 W VAN DORN AVE, HOLLY SPRINGS, MS 38635-2902
(662) 274-3212
(662) 274-3213
Mailing address
130 W VAN DORN AVE, HOLLY SPRINGS, MS 38635-2902
(662) 274-3212
(662) 274-3213
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04274797
—
MS
Enumeration date
11/13/2019
Last updated
04/03/2020
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