NPIMap

Organization Active NPI

Convenient Care Clinic, LLC

  • Family Nurse Practitioner
  • Horn Lake, MS
National Provider Identifier
1851490841
Registry record updated Aug 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
CONVENIENT CARE CLINIC, LLC
Practice address
3040 Goodman Rd West
Horn Lake, MS 38637-2474
Phone
(662) 578-2030
Fax
(615) 301-6550
NPI assigned
Sep 22, 2006
Last updated
Aug 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Stephanie Hicks
Title
Controller
Phone
(615) 988-2004

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Family Nurse Practitioner 363LF0000X Primary

Addresses

Primary practice location

3040 Goodman Rd West
Horn Lake, MS 38637-2474

Mailing address

30 Burton Hills Blvd
Suite 175
Nashville, TN 37215-6403
Phone (615) 864-8713

Other identifiers 1

IdentifierTypeStateIssuer
09015109MedicaidMS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120110000278 MS Part B Supplier - Clinic/Group Practice 1052587284 Receives reassigned benefits from 41 practitioners
Practice locations: Batesville, MS; Horn Lake, MS; Olive Branch, MS

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2065252Convenient Care Clinic, LLC3040 Goodman Road West, Horn Lake, MS 38637Certificate of waiverApr 28, 2027

National Provider Directory

National Provider Directory

Locations

555 Highway 6 E
Batesville, MS 38606
Phone (662) 578-2030

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Baptist Urgent CareBatesville, MS, CCN A53830 Rural health clinic 5% Or Greater Direct Ownership Interest Sep 12, 2012

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 45

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1754265600000",
    "number": "1851490841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 BURTON HILLS BLVD",
            "address_2": "SUITE 175",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372156403",
            "telephone_number": "615-864-8713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3040 GOODMAN RD WEST",
            "city": "HORN LAKE",
            "state": "MS",
            "postal_code": "386372474",
            "telephone_number": "662-578-2030",
            "fax_number": "615-301-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONVENIENT CARE CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-22",
        "last_updated": "2025-08-04",
        "certification_date": "2025-08-04",
        "status": "A",
        "authorized_official_last_name": "HICKS",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "615-988-2004"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "09015109",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Horn Lake, MS

Sources for this page

Verify at the official NPI Registry.