Healthcare Provider Details

I. General information

NPI: 1477739969
Provider Name (Legal Business Name): PATRICIA PORTERFIELD R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 FOOTE ST
CORINTH MS
38834-4834
US

IV. Provider business mailing address

PO BOX 839
CORINTH MS
38835-0839
US

V. Phone/Fax

Practice location:
  • Phone: 662-287-4424
  • Fax: 662-286-8095
Mailing address:
  • Phone: 662-286-2152
  • Fax: 662-286-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR862522
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: