Organization
PHYLLIS G KOONCE
Active
Other names
Cotton Plant Family Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. PHYLLIS G KOONCE CFNP (OWNER SOLE PROVIDER)
(662) 538-4111
Entity
Organization
Contact information
Practice address
100 COUNTY ROAD 714, BLUE MOUNTAIN, MS 38610-9743
(662) 538-4111
(662) 538-4128
Mailing address
100 COUNTY ROAD 714, BLUE MOUNTAIN, MS 38610-9743
(662) 538-4111
(662) 538-4128
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
R125960
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06577891
—
MS
Enumeration date
04/17/2007
Last updated
07/07/2008
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