Divinity Pediatric Clinic, Pllc
LBN: Divinity Pediatric Clinic, Pllc
Divinity Pediatric Clinic, Pllc is an health care organization with primary practice located at 200 Riverwind Dr Ste 104 , Pearl MS 39208-5652. The organization recently has 2 registered licenses in different health care specialties including Ambulatory Health Care Facilities / Primary Care, Physician Assistants & Advanced Practice Nursing Providers / Pediatrics. Physician Assistants & Advanced Practice Nursing Providers / Pediatrics is the primary health care specialty.
Divinity Pediatric Clinic, Pllc can be contacted via phone (601) 345-4044, or through Mccoy, Rekita D. via phone (601) 345-4044.
Contact Information
Primary practice address
200 Riverwind Dr Ste 104
Pearl MS 39208-5652
Phone: (601) 345-4044
Fax: (601) 510-9334
Website:
Authorized official contact:
Name: Mccoy, Rekita D. Family Nurse Practitioner (FNP)
Phone: (601) 345-4044
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Ambulatory Health Care Facilities / Primary Care | 261QP2300X | ||
| Physician Assistants & Advanced Practice Nursing Providers / Pediatrics | 363LP0200X |
Profile Details
| NPI number | 1629741152 |
|---|---|
| LBN Legal business name | Divinity Pediatric Clinic, Pllc |
| DBA Doing business as | |
| Authorized official | Mccoy, Rekita D. Family Nurse Practitioner (FNP) |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | Jul 29th, 2021 |
| Last updated | Sep 3rd, 2022 - about 4 years ago |
1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1629741152 | NPPES |
| Mississippi | MEDICAID | 1629741152 |
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