Organization · Type 2 NPI

Winston Medical Clinic Fair Elementary School

Family Nurse Practitioner · Louisville, MS

NPI number 1023474780 Active

Practice location

301 N Columbus Ave
Louisville, MS 39339-2315

Call (662) 446-1972 Map

Fax (662) 446-1039

Mailing address

PO Box 470
Louisville, MS 39339-0470

Specialties and licenses

Taxonomy	Code	License
Family Nurse Practitioner Primary	363LF0000X	R860217 (MS)

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NPI record

NPI: 1023474780
Entity type: Organization (Type 2)
Issued: Jan 12, 2016
Last updated: Jan 12, 2016
Status: Active
Subpart: Yes of Winston Medical Clinic LLC

Other names

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Winston Medical Clinic LLC · doing business as

Authorized official

Debra J Fryery
Director of Clinic Operations
(662) 446-1972

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1023474780

Winston Medical Clinic Fair Elementary School's National Provider Identifier is 1023474780, issued on Jan 12, 2016. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Louisville, MS. The record was last updated on Jan 12, 2016.