Healthcare Provider Details

I. General information

NPI: 1265630834
Provider Name (Legal Business Name): NEW BEGINNINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2007
Last Update Date: 07/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

79 PINK SMITH RD
CARRIERE MS
39426-8641
US

IV. Provider business mailing address

79 PINK SMITH RD
CARRIERE MS
39426-8641
US

V. Phone/Fax

Practice location:
  • Phone: 601-749-3887
  • Fax:
Mailing address:
  • Phone: 601-749-3887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberR606391
License Number StateMS

VIII. Authorized Official

Name: CAROLYN BLYTHE A. BLYTHE
Title or Position: PROVIDER
Credential: PHMNP
Phone: 601-749-3887