Provider Demographics
NPI:1962923573
Name:FAMILY FIRST HEALTHCARE CLINIC
Entity type:Organization
Organization Name:FAMILY FIRST HEALTHCARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KELLAR
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:601-347-7361
Mailing Address - Street 1:2322 HIGHWAY 43 S STE C
Mailing Address - Street 2:
Mailing Address - City:PICAYUNE
Mailing Address - State:MS
Mailing Address - Zip Code:39466-7325
Mailing Address - Country:US
Mailing Address - Phone:769-242-2525
Mailing Address - Fax:769-242-2526
Practice Address - Street 1:2322 HIGHWAY 43 S STE C
Practice Address - Street 2:
Practice Address - City:PICAYUNE
Practice Address - State:MS
Practice Address - Zip Code:39466-7325
Practice Address - Country:US
Practice Address - Phone:769-242-2525
Practice Address - Fax:769-242-2526
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901910261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center