Healthcare Provider Details

I. General information

NPI: 1366938102
Provider Name (Legal Business Name): ASHLEY RHODES MIZE DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY FAY RHODES RN

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ALCORN DR STE 1B
CORINTH MS
38834-9071
US

IV. Provider business mailing address

401 ALCORN DR STE 1B
CORINTH MS
38834-9071
US

V. Phone/Fax

Practice location:
  • Phone: 662-293-7390
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number902835
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: