Provider Demographics
NPI:1932470747
Name:ABOVE AVERAGE HEALTHCARE
Entity Type:Organization
Organization Name:ABOVE AVERAGE HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPN/ OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:WINSTON
Authorized Official - Last Name:GAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:601-594-7086
Mailing Address - Street 1:1280 OLD JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-7287
Mailing Address - Country:US
Mailing Address - Phone:601-594-7086
Mailing Address - Fax:601-878-5711
Practice Address - Street 1:1280 OLD JACKSON RD
Practice Address - Street 2:
Practice Address - City:TERRY
Practice Address - State:MS
Practice Address - Zip Code:39170-7287
Practice Address - Country:US
Practice Address - Phone:601-594-7086
Practice Address - Fax:601-878-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-25
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP316588164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty