| Natchez High/middle School Clinic | |
|
319 Sgt Prentiss Dr Natchez MS 39120-4225 | |
| (601) 786-3475 | |
| (601) 786-9980 |
| Full Name | Natchez High/middle School Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 319 Sgt Prentiss Dr, Natchez, Mississippi |
| Authorized Official Name and Position | Monica Lowe (INSURANCE CREDENTIALING SPECIALIST) |
| Authorized Official Contact | 6017863475 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Natchez High/middle School Clinic Po Box 98 Fayette MS 39069-0098 Ph: (601) 786-3475 | Natchez High/middle School Clinic 319 Sgt Prentiss Dr Natchez MS 39120-4225 Ph: (601) 786-3475 |
| NPI Number | 1538924840 |
|---|---|
| Provider Enumeration Date | 02/15/2024 |
| Last Update Date | 06/10/2026 |
| Certification Date | 06/10/2026 |
| Medicare PECOS PAC ID | 0345248100 |
|---|---|
| Medicare Enrollment ID | O20240412001971 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538924840 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (NU) | Primary |
| Provider Name | Kenitra Wallace |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1891218046 PECOS PAC ID: 3971036781 Enrollment ID: I20241101000222 |
| Provider Name | Jermonique King |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033531512 PECOS PAC ID: 9638602303 Enrollment ID: I20241101003539 |
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