Healthcare Provider Details

I. General information

NPI: 1669745303
Provider Name (Legal Business Name): CHRISTOPHER BYRON ARCEMENT NURSE PRACTITIONER(N
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2012
Last Update Date: 01/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5435 GEX RD.
DIAMONDHEAD MS
39525
US

IV. Provider business mailing address

149 DRINKWATER BLVD
BAY ST. LOUIS MS
39520
US

V. Phone/Fax

Practice location:
  • Phone: 228-255-8216
  • Fax: 228-255-8219
Mailing address:
  • Phone: 228-467-8600
  • Fax: 228-467-8799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR859319
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: