Organization Name: | CHILDREN'S ACCELERATION PROGRAM, INC |
NPI Number: | 1093865933 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DORIS MITCHELL (DIRECTOR) |
Mailing Address: | 112 Issaquena Ave Clarksdale |
State: | MS US |
Postal Code: | 386144315 |
Phone Number: | 6626272741 |
Fax Number: | |
NPI Enumeration Date: | 01/11/2007 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LP0200X |
License Number: | R125740 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Pediatrics |
Taxonomy Definition: |