Organization
LINE STREET MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEAH DENISE PHILLIPS FNP-C (NURSE PRACTITIONER)
(601) 562-6363
Entity
Organization
Contact information
Practice address
562 LINE ST S STE 1, PHILADELPHIA, MS 39350-2144
(601) 562-6363
Mailing address
562 LINE ST S STE 1, PHILADELPHIA, MS 39350-2144
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00724810
—
MS
Enumeration date
12/20/2018
Last updated
04/30/2020
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