Provider Demographics
NPI:1669299855
Name:PRIDE MEDICAL GROUP
Entity type:Organization
Organization Name:PRIDE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEKISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-CNP
Authorized Official - Phone:662-614-7606
Mailing Address - Street 1:1221 HARMON RD
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38606-8630
Mailing Address - Country:US
Mailing Address - Phone:662-614-7606
Mailing Address - Fax:662-214-6098
Practice Address - Street 1:456 HIGHWAY 6 E
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:MS
Practice Address - Zip Code:38606-3000
Practice Address - Country:US
Practice Address - Phone:682-233-4155
Practice Address - Fax:662-214-6098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-20
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty