MILESTONES PEDIATRIC CLINIC LLC NPI 1114543980

NPI Information

  • NPI: 1114543980
  • Provider Name: MILESTONES PEDIATRIC CLINIC, LLC
  • Classification: Nurse Practitioner - 363LP0200X
  • Specialization: Pediatrics
  • Entity Type: Organization
  • CLIA Number: 25D2186591
  • Address: 224 S CHURCH ST STE B
    BROOKHAVEN, MS
    ZIP 39601
  • Phone: (601) 990-4028

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NPI Details

MILESTONES PEDIATRIC CLINIC, LLC is a pediatrics nurse practitioner in Brookhaven, MS. MILESTONES PEDIATRIC CLINIC, LLC NPI is 1114543980. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

224 S CHURCH ST STE B
BROOKHAVEN, MS
ZIP 39601-232
Phone: (601) 990-4028

The provider's authorized official is Ashley Hatcher Hickman .
The authorized official title is Owner and has the following contact phone number (601) 990-4028.

The CLIA number assigned to this NPI record is 25D2186591 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/17/2020 and was last updated on 1/19/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LP0200XNurse PractitionerPediatricsYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1008700082MEDICAIDMISSISSIPPI

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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