NPIMap

Convenient Care Clinic, LLC

Organization Active NPI Family Nurse Practitioner · Horn Lake, MS

NPI 1851490841 · NPPES record last updated Aug 4, 2025

Key facts

NPI
1851490841
Entity type
Organization (NPI type 2)
Primary specialty
Family Nurse Practitioner 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
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 1

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

Other NPIs with the same Medicare PAC ID 1

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

Practitioners 45

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 45

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
25D2065252Convenient Care Clinic, LLC
3040 Goodman Road West, Horn Lake, MS 38637		Certificate of waiverApr 28, 2027

Medicare participation

Medicare fee-for-service enrollment
Enrolled in MS

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 Care
Batesville, MS · CCN A53830		 Rural health clinic 5% Or Greater Direct Ownership Interest Sep 12, 2012

Medicare enrollment records

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

National Provider Directory

Locations

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

5142 Goodman Rd
Olive Branch, MS 38654

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X
Family Nurse Practitioner
Group: 193400000X MULTIPLE SINGLE SPECIALTY GROUP		 363LF0000X Yes

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

IdentifierTypeStateIssuer
09015109MedicaidMS

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 4, 2025.

{
    "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": "193400000X MULTIPLE SINGLE SPECIALTY 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

All providers in Horn Lake, MS · Family Nurse Practitioner in Mississippi

Sources for this page

Verify at the official NPI Registry.