Organization
AA PRIMARY CARE SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA PARKER FNP-BC (OWNER)
(601) 554-6959
Entity
Organization
Contact information
Practice address
134 JERVIS MIMS RD, HATTIESBURG, MS 39401-8864
(601) 255-5705
Mailing address
134 JERVIS MIMS RD, HATTIESBURG, MS 39401-8864
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
R852821
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08657850
—
MS
01
—
12027545
CAQH
—
Enumeration date
05/17/2012
Last updated
09/08/2015
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