Provider Demographics
NPI:1083487334
Name:HEALTHYCONNECT OF MISSISSIPPI PLLC
Entity Type:Organization
Organization Name:HEALTHYCONNECT OF MISSISSIPPI PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:769-447-3042
Mailing Address - Street 1:1880 LAKELAND DR STE E
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4916
Mailing Address - Country:US
Mailing Address - Phone:769-447-3042
Mailing Address - Fax:769-447-3048
Practice Address - Street 1:1880 LAKELAND DR STE E
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4916
Practice Address - Country:US
Practice Address - Phone:769-447-3042
Practice Address - Fax:769-447-3048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Multi-Specialty