| Organization Name: | KIDS FIRST PEDIATRIC CLINIC, LLC |
| NPI Number: | 1356701783 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TIFFANY ROCHELLE JACKSON (FAMILY NURSE PRACTITIONER) |
| Mailing Address: | 529 Lake St Ste B Hazlehurst |
| State: | MS US |
| Postal Code: | 390832226 |
| Phone Number: | 6016688400 |
| Fax Number: | |
| NPI Enumeration Date: | 02/26/2016 |
| NPI Last Update Date: | 03/02/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 364SP0200X |
| License Number: | R881238 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MS |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Clinical Nurse Specialist |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |