Healthcare Provider Details

I. General information

NPI: 1508995499
Provider Name (Legal Business Name): MICHELLE RICE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 10/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BURKE CALHOUN CITY RD
CALHOUN CITY MS
38916
US

IV. Provider business mailing address

120 BURKE CALHOUN CITY RD PO BOX 1210
CALHOUN CITY MS
38916-9690
US

V. Phone/Fax

Practice location:
  • Phone: 662-628-5116
  • Fax: 662-628-5117
Mailing address:
  • Phone: 662-628-5116
  • Fax: 662-628-5117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR857851
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: