Healthcare Provider Details

I. General information

NPI: 1740920123
Provider Name (Legal Business Name): NPS WITH IVS HYDRATION AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2022
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13034 SHRINERS BLVD # B
BILOXI MS
39532-8250
US

IV. Provider business mailing address

13066 SHRINERS BLVD STE A
BILOXI MS
39532-8616
US

V. Phone/Fax

Practice location:
  • Phone: 228-333-0133
  • Fax: 228-901-5939
Mailing address:
  • Phone: 228-333-0133
  • Fax: 228-901-5939

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: GINA BUTLER
Title or Position: OWNER
Credential: NP
Phone: 228-697-4567