Organization · Type 2 NPI
Divinity Pediatric Clinic, PLLC
Pediatric Nurse Practitioner · Pearl, MS
NPI number
1629741152
Active
Practice location
200 Riverwind Dr Ste 104
Pearl, MS 39208-5652
Fax (601) 510-9334
Mailing address
463 Magnolia Pl
Brandon, MS 39042-8482
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Primary Care Clinic/Center | 261QP2300X | None listed |
| Pediatric Nurse Practitioner Primary | 363LP0200X | None listed |
Pediatric Nurse Practitioner: Definition to come...
Another provider at this address
About NPI 1629741152
Divinity Pediatric Clinic, PLLC's National Provider Identifier is 1629741152, issued on Jul 29, 2021. The primary taxonomy on file is Pediatric Nurse Practitioner (363LP0200X), and the practice location is in Pearl, MS. The record was last updated on Sep 3, 2022.