Organization
PUCKETT FAMILY MEDICAL CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ASHELY M SHIVERS NP (OWNER)
(601) 824-9490
Entity
Organization
Contact information
Practice address
6455 HIGHWAY 18, BRANDON, MS 39042-7536
(601) 824-9490
(601) 824-5855
Mailing address
PO BOX 580, PUCKETT, MS 39151-0580
(601) 824-9490
(601) 824-5855
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Enumeration date
08/16/2020
Last updated
08/16/2020
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