Provider Demographics
NPI:1982140448
Name:A HEALTHY YOU MEDICAL CLINIC, 'L.L.C.'
Entity Type:Organization
Organization Name:A HEALTHY YOU MEDICAL CLINIC, 'L.L.C.'
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LULA
Authorized Official - Middle Name:OWENS
Authorized Official - Last Name:HOSKINS
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:662-209-1202
Mailing Address - Street 1:1202 DESOTO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CLARKSDALE
Mailing Address - State:MS
Mailing Address - Zip Code:38614-6937
Mailing Address - Country:US
Mailing Address - Phone:662-209-1202
Mailing Address - Fax:662-483-1627
Practice Address - Street 1:1202 DESOTO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKSDALE
Practice Address - State:MS
Practice Address - Zip Code:38614-6937
Practice Address - Country:US
Practice Address - Phone:662-209-1202
Practice Address - Fax:662-483-1627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty