| Gateway Wellness Clinic | |
|
1016 Mission 66 Vicksburg MS 39183-2752 | |
| (601) 218-0969 | |
| Not Available |
| Full Name | Gateway Wellness Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 1016 Mission 66, Vicksburg, Mississippi |
| Authorized Official Name and Position | Kimberly Carson (OWNER) |
| Authorized Official Contact | 6012180969 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gateway Wellness Clinic Po Box 820472 Vicksburg MS 39182-0472 | Gateway Wellness Clinic 1016 Mission 66 Vicksburg MS 39183-2752 Ph: (601) 218-0969 |
| NPI Number | 1881567568 |
|---|---|
| Provider Enumeration Date | 09/29/2025 |
| Last Update Date | 09/29/2025 |
| Certification Date | 09/28/2025 |
| Medicare PECOS PAC ID | 0345736856 |
|---|---|
| Medicare Enrollment ID | O20260105003315 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881567568 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | () | Primary |
| Provider Name | Kimberly Shatwone Carson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174052773 PECOS PAC ID: 7810288818 Enrollment ID: I20170727002711 |
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