Wiley Clark Branch
Individual provider Active NPI Student in an Organized Health Care Education/Training Program · Durant, MS
NPI 1942979232 · NPPES record last updated Sep 9, 2021
Key facts
- NPI
- 1942979232
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Student in an Organized Health Care Education/Training Program 390200000X
- Practice address
- 89 W Cedar St
Durant, MS 39063-3509 - Phone
- (662) 417-3159
- NPI assigned
- Sep 9, 2021
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | |||
| Student in an Organized Health Care Education/Training Program | 390200000X | Yes |
Addresses
Primary practice location
89 W Cedar St
Durant, MS 39063-3509
Mailing address
89 W Cedar St
Durant, MS 39063-3509
Phone (662) 417-3159
Other providers in Durant, MS
- Adan'S Enterprise LLC
- Bell Dental Durant LLC
- Bell Pharmacy
- BSW Inc
- Durant Healthcare LLC
- Durant Primary Care Clinic
- Durant Public School District
- James Myers Ferguson
All providers in Durant, MS · Student in an Organized Health Care Education/Training Program in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 9, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.