Organization
PICAYUNE RURAL HEALTH CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTA KAY HODGE FNP (OWNER)
(601) 799-5577
Entity
Organization
Contact information
Practice address
317 N MAIN ST, PICAYUNE, MS 39466-3313
(601) 799-5577
(601) 799-5444
Mailing address
317 N MAIN ST, PICAYUNE, MS 39466-3313
(601) 799-5577
(601) 799-5444
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
13678
MS
363L00000X
Nurse Practitioner
Primary
R767181
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
09045721
—
MS
Enumeration date
09/20/2006
Last updated
08/18/2009
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