Provider Demographics
NPI:1992087019
Name:CARROLLTON FAMILY CLINIC
Entity type:Organization
Organization Name:CARROLLTON FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKAY
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:662-458-0225
Mailing Address - Street 1:PO BOX 192
Mailing Address - Street 2:
Mailing Address - City:NORTH CARROLLTON
Mailing Address - State:MS
Mailing Address - Zip Code:38947-0192
Mailing Address - Country:US
Mailing Address - Phone:662-237-4525
Mailing Address - Fax:
Practice Address - Street 1:502 GEORGE ST
Practice Address - Street 2:
Practice Address - City:NORTH CARROLLTON
Practice Address - State:MS
Practice Address - Zip Code:38947
Practice Address - Country:US
Practice Address - Phone:662-237-4525
Practice Address - Fax:662-237-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-14
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR852957363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty