OrganizationActive
Divinity Pediatric Clinic, PLLC
NPI 1629741152 · Pediatric Nurse Practitioner · Pearl, MS
Provider details
- NPI number
- 1629741152
- Entity type
- Organization
- Primary specialty
- Pediatric Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Organization subpart
- No
- Authorized official
- Rekita Mccoy, Ceo(601) 345-4044
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
- Primary Care Clinic/Center261QP2300X
Ambulatory Health Care Facilities
Practice location
200 Riverwind Dr Ste 104
Pearl, MS 39208-5652
Phone: (601) 345-4044
Fax: (601) 510-9334
Approximate (ZIP-level) locationGet directions
Mailing address
463 Magnolia Pl
Brandon, MS 39042-8482
Registry dates
- Enumerated
- 2021-07-29
- Last updated
- 2022-09-03
- Certified
- 2022-09-03
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.