Provider Demographics
NPI:1639973936
Name:BATESVILLE PEDIATRIC PLUS
Entity type:Organization
Organization Name:BATESVILLE PEDIATRIC PLUS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ FNP
Authorized Official - Prefix:
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:H
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:662-934-6516
Mailing Address - Street 1:4837 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:POPE
Mailing Address - State:MS
Mailing Address - Zip Code:38658-7245
Mailing Address - Country:US
Mailing Address - Phone:662-934-6516
Mailing Address - Fax:
Practice Address - Street 1:590 HIGHWAY 6 E
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3002
Practice Address - Country:US
Practice Address - Phone:662-934-6516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-03
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty