Organization Name: | LISTER HEALTHCARE CORPORATION |
NPI Number: | 1093962995 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | WESLEY LIVINGSTON (CEO) |
Mailing Address: | 123 Alcorn Dr Corinth |
State: | MS US |
Postal Code: | 388349359 |
Phone Number: | 2567677494 |
Fax Number: | |
NPI Enumeration Date: | 08/21/2008 |
NPI Last Update Date: | 08/21/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R851921 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MS |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |