Healthcare Provider Details

I. General information

NPI: 1053544155
Provider Name (Legal Business Name): LIGHTHOUSE HEALTHCARE NANCI W PARISH NP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 SIEBENKITTEL CIR SUITE E
CARRIERE MS
39426-8777
US

IV. Provider business mailing address

PO BOX 419
PICAYUNE MS
39466-0419
US

V. Phone/Fax

Practice location:
  • Phone: 601-798-2005
  • Fax: 601-798-2052
Mailing address:
  • Phone: 601-798-2005
  • Fax: 877-635-7892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR619442
License Number StateMS

VIII. Authorized Official

Name: NANCI W PARISH
Title or Position: OWNER
Credential: NP
Phone: 601-798-2005