Provider Demographics
NPI:1043386642
Name:FAMILY CARE CLINIC OF RIPLEY
Entity Type:Organization
Organization Name:FAMILY CARE CLINIC OF RIPLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:WANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:STROUPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-993-9336
Mailing Address - Street 1:PO BOX 4027
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38803-4027
Mailing Address - Country:US
Mailing Address - Phone:662-993-9336
Mailing Address - Fax:662-993-9338
Practice Address - Street 1:1007 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RIPLEY
Practice Address - State:MS
Practice Address - Zip Code:38663-1424
Practice Address - Country:US
Practice Address - Phone:662-993-9336
Practice Address - Fax:662-993-9338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03132873Medicaid
MSQ09026Medicare UPIN