Provider Demographics
NPI:1073390092
Name:HEALTHY YOU MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:HEALTHY YOU MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDLYNNE
Authorized Official - Middle Name:P
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-407-9955
Mailing Address - Street 1:PO BOX 1064
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MS
Mailing Address - Zip Code:39046-1064
Mailing Address - Country:US
Mailing Address - Phone:601-407-9955
Mailing Address - Fax:601-407-9874
Practice Address - Street 1:223 W CENTER ST STE B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MS
Practice Address - Zip Code:39046-3702
Practice Address - Country:US
Practice Address - Phone:601-407-9955
Practice Address - Fax:601-407-9874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-12
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty