Provider Demographics
NPI:1144775107
Name:NESHOBA COUNTY GENERAL HOSPITAL
Entity Type:Organization
Organization Name:NESHOBA COUNTY GENERAL HOSPITAL
Other - Org Name:NESHOBA URGENT CARE CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:KIRKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:601-656-1465
Mailing Address - Street 1:1120 E MAIN ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PHILADELPHIA
Mailing Address - State:MS
Mailing Address - Zip Code:39350-2300
Mailing Address - Country:US
Mailing Address - Phone:601-656-1465
Mailing Address - Fax:601-656-2752
Practice Address - Street 1:1120 E MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:PHILADELPHIA
Practice Address - State:MS
Practice Address - Zip Code:39350-2300
Practice Address - Country:US
Practice Address - Phone:601-656-1465
Practice Address - Fax:601-656-2752
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NESHOBA COUNTY GENERAL HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSPENDINGMedicaid