is a Nurse Practitioner in Vancleave, Mississippi. practices all healthcare services and medical treatments related to Nurse Practitioner. The NPI Number for is 1164689071. The last update date is .
's current location address is 11700 Highway 57, Vancleave, Mississippi. You can contact this provider via phone number 2288261482 and fax number 2288265924. The mailing address for is 11700 Highway 57, Vancleave, Mississippi. To know further, please read the information below!
Provider Profile Detail
| Provider Name | |
|---|---|
| Address | 11700 Highway 57, Vancleave, Mississippi |
| Phone Number | 2288261482 |
| Fax Number | 2288265924 |
| Sole Proprietor | -- |
| Credentials | -- |
NPI Number Detail
| NPI Number | 1164689071 |
|---|---|
| Provider Enumeration Date | |
| Last Updated Date |
Provider Mailing Address Detail
| Address | 11700 Highway 57 |
|---|---|
| City | Vancleave |
| State | Mississippi (MS) |
| Post Code | 395658309 |
| Phone Number | 2288261482 |
| Fax Number | 2288265924 |
Provider's Primary Taxonomy Detail
| Speciality | Nurse Practitioner |
|---|---|
| Taxonomy | 363L00000X |
| Licence No | R866158 |
|
Definition: (1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision making and direct accountability for clinical judgment across the health care continuum or in a certifi |
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Provider's Other Legacy Identifiers
| Identifier | Identifier Type | Identifier State | Identifier Issuer |
|---|---|---|---|
| 7351098 | MS | -- |
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