Provider Demographics
NPI:1679600522
Name:KOSSUTH FAMILY HEALTH CLINIC
Entity Type:Organization
Organization Name:KOSSUTH FAMILY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HAYHURST
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, APRN, BC FNP
Authorized Official - Phone:662-286-5055
Mailing Address - Street 1:PO BOX 8023
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-8023
Mailing Address - Country:US
Mailing Address - Phone:662-286-5055
Mailing Address - Fax:662-286-9700
Practice Address - Street 1:820 HIGHWAY 2
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-7954
Practice Address - Country:US
Practice Address - Phone:662-286-5055
Practice Address - Fax:662-286-9700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR560634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08788775Medicaid
MS08788775Medicaid