Healthcare Provider Details

I. General information

NPI: 1578422150
Provider Name (Legal Business Name): RONNIE GLADNEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2026
Last Update Date: 01/19/2026
Certification Date: 01/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NW DEPOT ST
DURANT MS
39063-3705
US

IV. Provider business mailing address

401 NW DEPOT ST
DURANT MS
39063-3705
US

V. Phone/Fax

Practice location:
  • Phone: 662-394-1302
  • Fax: 662-653-3829
Mailing address:
  • Phone: 662-394-1302
  • Fax: 662-653-3829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: