Provider Demographics
NPI:1528210986
Name:PRIMARY SOLUTIONS FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:PRIMARY SOLUTIONS FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTY
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC
Authorized Official - Phone:601-209-3670
Mailing Address - Street 1:1008 CALHOUN AVE
Mailing Address - Street 2:
Mailing Address - City:YAZOO CITY
Mailing Address - State:MS
Mailing Address - Zip Code:39194-2938
Mailing Address - Country:US
Mailing Address - Phone:662-751-8847
Mailing Address - Fax:662-751-8848
Practice Address - Street 1:1008 CALHOUN AVE
Practice Address - Street 2:
Practice Address - City:YAZOO CITY
Practice Address - State:MS
Practice Address - Zip Code:39194-2938
Practice Address - Country:US
Practice Address - Phone:662-751-8847
Practice Address - Fax:662-751-8848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR866077363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS500002272OtherMEDICARE
MS1003984592OtherNPI-INDIVIDUAL
MS9083527Medicaid