Provider Demographics
NPI:1184120883
Name:LENA FAMILY MEDICAL, INC.
Entity type:Organization
Organization Name:LENA FAMILY MEDICAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:601-654-3433
Mailing Address - Street 1:1107 GRAND AVENUE
Mailing Address - Street 2:P.O. BOX 295
Mailing Address - City:LENA
Mailing Address - State:MS
Mailing Address - Zip Code:39094
Mailing Address - Country:US
Mailing Address - Phone:601-654-3433
Mailing Address - Fax:601-654-0117
Practice Address - Street 1:1107 GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:LENA
Practice Address - State:MS
Practice Address - Zip Code:39094
Practice Address - Country:US
Practice Address - Phone:601-654-3433
Practice Address - Fax:601-654-0117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care