Provider Demographics
NPI:1003418997
Name:KIDNEY FOCUSED CARE, LLC
Entity Type:Organization
Organization Name:KIDNEY FOCUSED CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:DIANE
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:601-665-4429
Mailing Address - Street 1:702 PECAN CT
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39042-6012
Mailing Address - Country:US
Mailing Address - Phone:662-719-9120
Mailing Address - Fax:601-665-4429
Practice Address - Street 1:2633 RIDGEWOOD RD STE 105
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4962
Practice Address - Country:US
Practice Address - Phone:601-665-4429
Practice Address - Fax:601-665-4429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-15
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty