| Organization Name: | THE RAINBOW CHILDREN'S CLINIC |
| NPI Number: | 1033370580 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | PORTIA F TRAVIS (NURSE PRACTITIONER) |
| Mailing Address: | 730 E Fifteenth St Yazoo City |
| State: | MS US |
| Postal Code: | 391942706 |
| Phone Number: | 6627518566 |
| Fax Number: | |
| NPI Enumeration Date: | 06/18/2008 |
| NPI Last Update Date: | 06/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | R800172 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |