Provider Demographics
NPI:1639764020
Name:CARING HANDS CHILDREN'S CLINIC II, LLC
Entity Type:Organization
Organization Name:CARING HANDS CHILDREN'S CLINIC II, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEONTRANESE
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:601-754-0772
Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:MS
Mailing Address - Zip Code:39654-1400
Mailing Address - Country:US
Mailing Address - Phone:601-587-4304
Mailing Address - Fax:601-587-4515
Practice Address - Street 1:29 SECOND ST.
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:MS
Practice Address - Zip Code:39653-3965
Practice Address - Country:US
Practice Address - Phone:601-587-4304
Practice Address - Fax:601-587-4515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-08
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty