Excellence Concierge Medicine LLC
Nurse Practitioner, Community Health in Olive Branch, MS. Organization (NPI-2).
NPI number1124718366
StatusActive
Last updated in NPPESMay 10, 2023
Details
- NPI
- 1124718366
- Entity type
- Organization (NPI-2)
- Legal business name
- Excellence Concierge Medicine LLC
- Organization subpart
- No
- Enumeration date
- May 10, 2023
- Certification date
- May 8, 2023
- Last updated
- May 10, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363LC1500X | Nurse Practitioner, Community Health | – | – | Yes |
Practice location
7712 Keri CvOlive Branch, MS 38654-5049
Phone 901-832-6805
Mailing address
6515 Goodman RdSuite 4 Box 298
Olive Branch, MS 38654
Phone 901-832-6805
Authorized official
Miranda D White
Fnp/Ceo
9018326805
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