Organization
PICAYUNE PEDIATRICS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETTY JO ALEXANDER CPNP (OWNER)
(601) 590-1045
Entity
Organization
Contact information
Practice address
200 COUNTRY CLUB RD, CARRIERE, MS 39426-9037
(601) 590-1045
Mailing address
1704 W FOURTH AVE, PICAYUNE, MS 39466-3112
(601) 590-1045
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
Primary
R687693
MS
Other
Enumeration date
12/21/2015
Last updated
12/22/2015
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