Organization
HICKORY FLAT FAMILY CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENISE WELLS GOSSETT CFNP (NURSE PRACTITIONER)
(662) 202-5685
Entity
Organization
Contact information
Practice address
250 OAK STREET, HICKOR FLAT, MS 38633
(662) 333-6378
Mailing address
PO BOX 128, HICKORY FLAT, MS 38633-0128
(662) 333-6387
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
R687235
MS
Other
Enumeration date
05/09/2008
Last updated
05/09/2008
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