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809 CONVENIENT CARE CLINIC
NPI 1063659340
Nurse Practitioner - Family in Jackson, MS

Active since January 08, 2009
809 N STATE ST, JACKSON, MS 39202(601) 982-0673(601) 982-0459 Get Directions Write a Review

NPPES record last updated: January 8, 2009. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About 809 Convenient Care Clinic NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

809 CONVENIENT CARE CLINIC (NPI 1063659340) is a healthcare organization registered as a family in Jackson, Mississippi and active in the NPI registry since January 2009. The organization lists Christal Rogers, Office Assistant, as its authorized official.

NPPES Registry Identity

NPI1063659340
Entity TypeOrganization
Primary Taxonomy363LF0000X
Legal Business NameMALL SERVICES, LLC
Location Address809 N STATE STJackson, MS 39202-2604
Mailing Address350 W Woodrow Wilson Ave, Suite 615Jackson, MS 39213-7681 · (601) 982-0673 · Fax (601) 982-0459
Phone(601) 982-0673
Fax(601) 982-0459
Organization SubpartNo
Authorized OfficialChristal RogersOffice Assistant · (601) 982-0673
Enumeration DateJanuary 8, 2009
✔ NPI 1063659340 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
License✔ Licensed in MS · R656046
Also ListedCommunity Health WorkerTaxonomy 172V00000X · License P320574 (MS)
809 N STATE ST, Jackson, MS 39202
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Other Names 1

Doing Business As809 Convenient Care Clinic

Other Identifiers 2

Medicaid00115980MS
Medicaid08406271MS

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X MULTIPLE SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 4

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

COMPLETE PHYSICAL THERAPY, LLC
Clinic/Center (Physical Therapy)
809 N STATE ST
JACKSON, MS 39202
Hinds County (601) 354-5722
MISS NIKI T.S SINGLETARY MPT
Physical Therapist
809 N STATE ST
JACKSON, MS 39202
Hinds County (601) 354-5722
REBECCA LEE REYNOLDS COTA/L
Occupational Therapy Assistant
809 N STATE ST
JACKSON, MS 39202
Hinds County (601) 720-7206
CORTNEY DEARMAN
Physical Therapy Assistant
809 N STATE ST
JACKSON, MS 39202
Hinds County (769) 216-3288

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mall Services, LLC's NPI number?

The NPI number for Mall Services, LLC is 1063659340. It was assigned to this organization in the NPPES registry on January 8, 2009. The provider is doing business as 809 Convenient Care Clinic.

Where is Mall Services, LLC located?

Mall Services, LLC is located at 809 N State St, Jackson, MS 39202. The listed phone number is (601) 982-0673.

What is Mall Services, LLC's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

When was this NPI record last updated?

The NPPES record for Mall Services, LLC was last updated on January 8, 2009. NPI Profile syncs with the weekly NPPES data releases published by CMS.