Magnolia Family Clinic
Organization Active NPI Family Medicine Physician · Rienzi, MS
NPI 1508303348 · NPPES record last updated Jul 15, 2022
Key facts
- NPI
- 1508303348
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- MAGNOLIA FAMILY CLINIC
- Practice address
- 82 Main St
Rienzi, MS 38865-9144 - Phone
- (662) 293-6699
- Fax
- (662) 293-6698
- NPI assigned
- Jan 31, 2017
- Organization subpart
- Yes
- Parent organization (as reported)
- MAGNOLIA REGIONAL HEALTH CENTER
Authorized official
- Name
- Mrs. Deonne Henry
- Title
- Executive Director
- Phone
- (662) 293-1076
Corporate family (same tax ID) 1
Practitioners 5
-
Jennifer Elaine Pickens, FNP-BC
-
Brittney Leeann Plunk, FNP-C
-
Laquita Gay Bain, FNP
-
Erica Lynn Yates, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170418000447 | MS | Part B Supplier - Clinic/Group Practice | 3072899541 |
Receives reassigned benefits from 5 practitioners Practice locations: Rienzi, MS |
National Provider Directory
- Tax ID family
- Magnolia Family Clinic
- Part of
- Magnolia Hospital Ekg
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
82 Main St
Rienzi, MS 38865-9144
Mailing address
401 Alcorn Dr Ste 2C
Corinth, MS 38834-9073
Phone (662) 293-7618
Other providers in Rienzi, MS
- Everley Brooke Coats
- Jonathan Derick Dodds
- Melinda Rutledge Hamlin
- Magnolia Regional Health Center
- Yvette Lynn Morton
- Parker Imaging, LLC
- Amy N. Parker
- Joy Allen Price
All providers in Rienzi, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 15, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.