NPI 1891150629

Picayune Pediatrics LLC

Organisation Preferred Provider Organization Carriere, MS

Practice location

Address: 200 Country Club Rd, Carriere, MS 39426-9037
Phone: (601) 590-1045
Mailing address: 1704 W Fourth Ave, Picayune, MS 39466-3112

Authorised official

Name: Betty Jo Alexander
Title: Owner
Phone: (601) 590-1045

Registered specialties

Preferred Provider Organization Primary

Managed Care Organizations Taxonomy 305R00000X Licence R687693 (MS)

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Registry record

NPI: 1891150629
Entity type: Organization
NPI issued: 21 Dec 2015
Record last updated: 22 Dec 2015

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.